Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry.

Introduction: In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned. Patients and methods: We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF. Results: Syphilitic etiology was retained for six (6) patients (4 men and 2 women) with a mean age of 43 years (extremes 36 and 49 years). The clinical picture was dominated by carotid syndromes: superficial and deep sylvian syndrome, anterior cerebral artery syndrome and vertebro-basilar syndromes and one case of lacunar syndrome.The diagnosis was based on the positivity of serological reactions (VDRL-TPHA) in blood and cerebrospinal fluid (CSF) and the presence of a predominantly lymphocytic hypercellularity and a hyperproteinorachy in the CSF in the absence of any other etiology. Conclusion: These neurological vascular syndromes consecutive to a cerebral treponematous attack are often the result of a still poorly conducted management of primary and secondary syphilis in our country.

[Surgical treatment of chronic subdural hematoma in Guinea: Analysis of 22 cases at the Kipe hospital of Conakry]. / Traitement chirurgical des hématomes sous-duraux chroniques en Guinée : étude de 22 cas à l'hôpital Kipe de Conakry.

OBJECTIVE: We report the results of surgical treatment of chronic subdural hematoma in the Kipe Hospital in Conakry, Guinea, for the period July 2012 to November 2015. MATERIAL AND METHOD: Clinical, radiological and therapeutic data from 22 cases were collected retrospectively and analyzed, with a mean follow-up of 61.6 days. Univariate analysis screened for factors for neurological outcome on the Markwalder Grading Scale (MGS; 0=normal to 4=coma). RESULTS: Male-female sex ratio was 2.6:1. Mean age at diagnosis was 71.09±8 years, with peak incidence of CSDH in the 60-79 age group. Traumatic brain injury was identified as causal in 40.9% of cases. Burrhole trepanation was used in 86.36% of cases, under local anesthesia in 76%, and with postoperative drainage in all cases. No recurrences were recorded. At follow-up, mean postoperative MGS was 0.59 (up from 3.08 preoperatively); 54.54% of patients had normal neurological examination (grade 0). Age 60-79 years, time to diagnosis>12 weeks and preoperative MGS≥3 had significant negative impact on outcome (respective P-values: 0.03, 0.001, 0.001). CONCLUSION: Our data were similar to those of the literature, but with longer time to diagnosis and poorer initial clinical status, with negative impact on clinical progression.

[A continuous series of 27 adult patients treated for L5-S1 isthmic spondylolisthesis by combined approach: Clinical and radiological outcomes at 1 year follow-up]. / Une série continue de 27 patients adultes opérés d'un spondylolisthésis isthmique L5-S1 par voie combinée : résultats cliniques et radiologiques à 1 an de suivi.

Through this single-center consecutive prospective study, we evaluated the results of a combined approach for L5-S1 isthmic spondylolisthesis, using a polyetheretherketone (PEEK) interbody lordotic cage during anterior approach and pedicle screw-based posterior fixation. Between 2010 and 2014, 27 adult patients were treated for L5-S1 isthmic spondylolisthesis (high and low grades) by a combined approach with a minimum follow-up of one year. Clinical outcome was assessed before surgical treatment and at four months and one year after surgery by: VAS, Oswestry Index (ODI) and Rolland-Morris scores. Two observers evaluated the following radiological parameters: pelvic incidence, pelvic tilt, lumbar lordosis, segmental lordosis L5-S1, anterior and posterior disc height, spinal vertical axis (SVA), SVA/sacro-femoral distance (SFD) ratio. Fusion was evaluated on the CT scan at one-year follow-up. Blood loss, surgery time and complications were also collected. The mean age was 47.7 years (±16.9). The VAS, ODI and Rolland-Morris scores were significantly improved postoperatively, decreased from 7.5 (±1.45); 48 (±19.25); 15.3 (±4.67) before the surgery to 3.8 (±2.55); 28.7 (±19.58) and 7.76 (±7.21) respectively at one year after the surgery (P=0.05). The mean follow-up was 3.3 years. Mean surgery time was 193.7min (±37). Fusion was obtained in 100% of cases. Segmental lordosis L5-S1, pelvic tilt, slippage, anterior and posterior L5-S1 disc height were significantly improved postoperatively, they passed from 20.1; 22.6; 35.3%; 26.4%; 17.9% to 29.5; 20.6; 20.3%; 64.4%; 36.3% respectively. Combined surgical procedure meets the required goals of surgery in the treatment of adults L5-S1 isthmic spondylolisthesis.

[Profile of cranio-cerebral trauma and spinal cord trauma related road accidents in Guinea]. / Profil des traumatismes crânio-encéphalique et vertébro-médullaire liés aux accidents de la voie publique en Guinée.

OBJECTIVE: To describe the profile of the patient injured in traffic accidents and having a cranio-cerebral trauma (CCT) or spinal cord trauma (SCT). METHOD: Cross-sectional and retrospective survey of records management in 2829 road accident victims with CCT and/or a SCT and admitted to a hospital in Guinea between 1st January and 31st December, 2009. The profile was described by: the sociodemographic data, the circumstances of the accident and the clinical, therapeutic and follow-up data. RESULTS: For an average age of 27.1±12.7 years, the location of the trauma was cranio-cerebral in 82.0% of cases, spinal in 8.9% of cases and mixed in 9.1%. A large proportion of CCT (66.3%) and mixed trauma (63.1%) comes from to two-wheeled vehicles, while the large proportion of SCT (54.2%) is attributable to vehicles with four wheels. The Glasgow Coma average was 13.2±2.6 at admission, 21.7% of the victims are taken in charge beyond the first 12hours after the accident. Only 19.2% of patients underwent a surgical treatment with a hospital mortality ranging from 3.3 % (TVM) to 7.7% (mixed). CONCLUSION: CCT and SCT are characterized by an age under 30 years and male predominance. The support care suffers greatly from the unbalanced distribution of qualified personnel on the national territory and the lack of material means.

[Clinical and tomographic aspects of 29 cases of phakomatosis in Guinea]. / Aspects clinique et scannographique de 29 observations de phacomatoses en Guinée.

The purpose of this report is to describe 29 cases of phakomatosis including 18 cases of tuberous sclerosis (Bourneville) and 11 cases of neurofibromatosis (von Recklinghausen) observed over a 10-year period at the Neurology Department of the University Hospital Centre in Conakry, Guinea. Findings during this period were consistent with those classically reported in the literature: high frequency of advanced skin lesions coalescing into massive tumours, occurrence of seizures of all types and development of a wide variety of complications as a result of late diagnosis. Our experience underscores the need for follow-up and surveillance of these patients by somatic studies based on neurological, ophthalmologic and tomographic data depending on clinical findings.

[Late occurrence of first epileptic seizures: a 42-case series]. / Premières crises epileptiques tardives. Etude de 42 cas.

Late occurrence of epilepsy is common in tropical areas. This report describes a series of 42 cases of late epilepsy collected over a three-year period. Findings were consistent with the literature: highest incidence in young age groups, predominance of partial symptomatic epilepsy, and wide spectrum of etiologies. The most frequent etiology was tumoral disease followed by vascular and infectious disease. Brain CT scan and electro-encephalography were highly useful for identification of clinical and etiological entities.

[Wilson's disease: study of 6 neurologic forms observed at the University Hospital in Conakry]. / Maladie de Wilson: étude de 6 formes neurologiques observées au CHU de Conakry.

This report describes 6 cases of Wilson's disease observed at the University Hospital Center in Conakry, Guinea. Presenting symptoms involved extrapyramidal syndrome in 4 cases, psychomotor epilepsy in 1, and confusional syndrome in 1 case. Diagnosis was based on neuropsychic manifestations, Kayser-Fleicher corneal ring, liver failure, and impaired copper metabolism. Brain CT-scan depicted normal features in 3 cases, symmetric hypodensity of the lenticular nucleus in one, discrete ventricular dilatation of in one a and cortico-subcoetical atrophy in one.

Premieres crises epileptiques tardives etude de 42 cas

Late occurrence of epilepsy is common in tropical areas. This report describes a series of 42 cases of late epilepsy collected over a three-year period. Findings were consistent with the literature: highest incidence in young age groups; predominance of partial symptomatic epilepsy; and wide spectrum of etiologies. The most frequent etiology was tumoral disease followed by vascular and infectious disease. Brain CT scan and electro-encephalography were highly useful for identification of clinical and etiological entities

[Atypical neurosyphilis: 28 cases observed at the University Hospital Center of Conakry]. / Neurosyphilis atypique etude de 28 cas observes au CHU de Conakry.

This study describes a series of 28 cases of neurosyphylis presenting atypical oligosymptomatic syndromes involving epileptic attack, chronic headache, peripheral facial paralysis, deafness, isolated optic atrophy, and cerebral ataxia. Diagnosis was based on positive results (VDRL-TPHA) of serological reactions in blood samples and analysis of cerebrospinal fluid showing pleocytosis (mean lymphocyte level, 69%) and elevated protein levels. Epilepsy and chronic headache were the most common clinical manifestations. Brain scan demonstrated low-grade ventricular dilatation associated with nonspecific cerebral atrophy in 8 cases and isolated cerebral atrophy in three. In the remaining 17 cases brain scans were normal.

[Subacute sclerosing panencephalitis. Study of 32 cases observed in Conakry, Guinea]. / Panencéphalite sclérosante subaiguë. Etude de 32 cas observés à Conakry, Guinée.

Thirty two cases of subacute sclerosing panencephalitis were reported. Diagnosis was based on epidemiological, clinical and electroencephalographic data; myoclonies and alterations of intellectual functions were the most frequent symptoms.