Transverse facial artery: Its role in blindness after cosmetic filler and botulinum toxin injections.

Masseter injections for cosmetic or pathological reasons are increasingly common, as are filler injections using dual or multiplane techniques in the lateral facial regions or for jawline contouring. The occurrence of blindness following these procedures often remains unexplained. This study aimed to determine the anatomical explanation for this debilitating complication by investigating the transverse facial artery and its relation to the masseter. For this purpose, we dissected 35 cheek specimens with latex injections and 10 specimens without latex. The external carotid artery was dissected up to its bifurcation into the maxillary and superficial temporal arteries. Results showed that the transverse facial artery arose from the superficial temporal or external carotid artery that runs between the zygomatic arch and the parotid duct. Three types of transverse facial arteries were observed: type I: a short artery that did not extend beyond the masseter muscle; type II: a transverse artery that ran to the nasolabial fold and anastomosed to the facial artery; and type III: a sizable transverse artery that substituted the hypoplastic facial artery, continued as the angular artery, and then anastomosed to the dorsal nasal artery. Knowledge of these three types of transverse facial arteries is a prerequisite to study the vascular territory. Type III provides an explanation for the occurrence of blindness after lateral face injections. We consequently define a line that runs from the tragus to the outer quarter of the upper lip as the risk area, while the safe zone is located on either side of this line.

A critical analysis of the impacts of COVID-19 on the global economy and ecosystems and opportunities for circular economy strategies.

The World Health Organization declared COVID-19 a global pandemic on the 11th of March 2020, but the world is still reeling from its aftermath. Originating from China, cases quickly spread across the globe, prompting the implementation of stringent measures by world governments in efforts to isolate cases and limit the transmission rate of the virus. These measures have however shattered the core sustaining pillars of the modern world economies as global trade and cooperation succumbed to nationalist focus and competition for scarce supplies. Against this backdrop, this paper presents a critical review of the catalogue of negative and positive impacts of the pandemic and proffers perspectives on how it can be leveraged to steer towards a better, more resilient low-carbon economy. The paper diagnosed the danger of relying on pandemic-driven benefits to achieving sustainable development goals and emphasizes a need for a decisive, fundamental structural change to the dynamics of how we live. It argues for a rethink of the present global economic growth model, shaped by a linear economy system and sustained by profiteering and energy-gulping manufacturing processes, in favour of a more sustainable model recalibrated on circular economy (CE) framework. Building on evidence in support of CE as a vehicle for balancing the complex equation of accomplishing profit with minimal environmental harms, the paper outlines concrete sector-specific recommendations on CE-related solutions as a catalyst for the global economic growth and development in a resilient post-COVID-19 world.

What is the nutritional status of your patients suffering from strokes.

Strokes can significantly affect the autonomy and the ability of the patient to feed properly. Malnutrition after strokes increases the length of stay in hospital, increases mortality and aggravates disability. Nutritional support is a therapeutic that can be useful in the management of strokes and during the rehabilitation period. It may help to reduce the occurrence of complications due to the physical dependence associated with this condition. The objective of our study was to evaluate, through a questionnaire, the opinion of prescribing doctors working in the Department of Neurology of The FANN National Teaching Hospital in Dakar. The interest of the question resides in the fact that the Center does not have a dedicated nutritionist for inpatients. This was an opinion poll about their concerns about the nutritional status of patients in the therapeutic projects they propose during the stroke. The type of the chosen opinion poll was elementary, type random. The questionnaire was individual and consisted of five items of single-response and multiple-choice questions. The results of this study reveal that while the nutritional status of patients with limited autonomy in the service was a concern in the intentions of the prescribers, in practice it was not taken into account in therapeutic projects. To date, no structured protocol is available in cases of proven nutritional deterioration in patients. Nutritional management must be integrated into the overall management of Neurology patients, particularly in elderly victims of strokes.

Childhood arterial ischemic stroke in Senegal (West Africa).

Etiological factors of childhood ischemic stroke depend on the epidemiological context. The purpose of this study was to determine the risk factors, the clinical and radiologic features, and the outcome of arterial ischemic stroke in a case series of Senegalese children. We carried out a retrospective registry-based study on arterial ischemic stroke in children hospitalized in the neurology department of Fann Teaching Hospital and Albert Royer Children's Hospital, from January 2005 to December 2015. We enrolled 116 cases with an age range from 2 months to 18 years. The mean age at stroke occurrence was 71.5 months. The most common manifestations were hemiparesis (84%), aphasia (19%), and partial motor seizures (10%). The middle cerebral artery was the most affected (81%). Risk factors were predominantly sickle cell disease (38%), embolic heart disease (9%), and anemia (3%). Twenty-eight percent of patients were lost to follow-up, 62% had neurological impairments, and 4% died. Secondary prevention was based on antithrombotic agents. Prevention must be prioritized and public health actions need to focus on sickle cell disease, rheumatismal disease, anemia, and related disorders. It will be necessary to set up policies that fight against consanguineous marriage, endemic infections, and argue for better nutrition.

[Ito hypomelanosis: Four case reports]. / Hypomélanose d'Ito : à propos de 4 cas.

Ito hypomelanosis is a rare neurocutaneous condition. We report on four observations in infants aged between 8 and 20 months. They all presented with epilepsy, psychomotor delay, and diffuse hypomelanosis. The electroencephalograms showed diffuse irritative abnormalities. Brain imaging was normal in two infants and showed hemispheric atrophy in another case. Despite antiepileptic treatment and physical therapy, no significant progression was noted and all children continued to have drug-resistant epilepsy and psychomotor delay.

Sleep quality assessment in 35 Parkinson's disease patients in the Fann Teaching Hospital, Dakar, Senegal.

INTRODUCTION: Sleep disorders are diverse in Parkinson's disease. We aimed to assess the quality of sleep in patients with Parkinson's disease in an African population. METHODS: In a transversal and prospective study from April to June 2014, all parkinsonian patients followed at the Fann Teaching Hospital Neurology Clinic (Dakar, Senegal) were assessed using the Hoehn and Yahr's scale and filled out the following questionnaires: Parkinson's disease sleep scale (PDSS), the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS). A PDSS score<82 (or a subscore<5) and a PSQI score>5 indicated poor quality or impaired sleep. An ESS score>10 indicated excessive daytime sleepiness. We used the Pearson coefficient to search for correlation between age, disease stage, disease duration, and the importance of sleep impairment. RESULTS: Hoehn and Yahr staging was 2.42±0.90 in the 35 patients (60% male, mean age 65.7±7.4years, disease duration 32.4±23.4months). The mean total PDSS score was 99.5±24.1 and 74.3% of the patients had an abnormally high PSQI score, indicating high frequency and intensity of sleep disorders. Most frequent disorders were pain or cramps interrupting sleep, night waking to urinate and fatigue or sleepiness on waking. Patients exhibited excessive diurnal sleepiness in 22.9% of the cases; they often had an abnormal PSQI score. Both the total PDSS score and the difficulty to sleep increased with disease stage, but not with age or disease duration. CONCLUSION: We found evidence of major alteration of sleep quality in Senegalese Parkinson patients.

[Myeloradiculitis due to Schistosoma haematobium: about an observation in Dakar (Senegal)]. / Myéloradiculite à Schistosoma haematobium : à propos d'une observation à Dakar (Sénégal).

Nervous localisations of schistosomiasis are rare. We report the case of a 25 year-old Senegalese patient admitted for a progressive myeloradiculitis onset, over a one week period. The diagnosis of Schistosoma haematobium myeloradiculitis was made in front of a positive serum serology for S. haematobium, presence of S. haematobium eggs in urine, hyperproteinorachia, endemicity of S. haematobium in the region where the patient was originating and a past medical history of macroscopic hematuria in a context of river bathing. There was also no arguments for another cause to these neurological manifestations. Our patient was treated with praziquantel, prednisone and physiotherapy. Evolution was marked 6 weeks after the beginning of treatment by a significant improvement of motor deficit, enabling the patient to walk again. There was also a regression of genitosphincter dysfunction. Work-up for patients presenting with paraplegia in tropical countries, should also include search for S. heamatobium infection.

Prognosis of spontaneous hemorrhagic stroke in people under 55 in Senegal, a developing country in Africa: a series of 53 cases.

Strokes occur increasingly frequently in people aged 55 years or younger and present a problem of management and therefore of prognosis. The objective of this study was to determine the prognostic factors associated with hemorrhagic stroke in this population in Senegal. This retrospective study concerns 53 patients aged 16 to 55 years, hospitalized for hemorrhage stroke in the neurological department of Fann Teaching Hospital during 2010. The patients' mean age was 42.1 years (16 to 55 years) and the sex ratio 1.30 in favor of women. Hypertension was found in 62% of the patients, and 11% had a history of stroke. Hemiplegia was observed in 76%, associated more or less with impairment of consciousness (43%) and language (38%). Intraparenchymal hematomas were principally supratentorial (78%); only 15% were subtentorial (10% cerebellar and 5% in the brainstem). During the acute phase of hemorrhage, glycemic levels were high among one third of the patients. The mortality rate in our series was 43% and was highest among those of impaired consciousness and abnormal glycemic, cholesterol, and creatinemia levels. Neuropsychological sequelae occurred in 47% of all patients, including 83% of the survivors. Hemorrhagic stroke in people aged 55 years or younger is a public health problem. In view of the high mortality rate, effective control requires prevention of its risk factors and increased awareness of the danger of these factors and of the warning signs of stroke.

[Epilepsy and reproductive health: Senegalese cohort]. / Épilepsie et santé de la reproduction : cohorte sénégalaise.

INTRODUCTION: Epilepsy is a public health problem in Senegal and Africa because of its severity and its social importance. It occurs at any age sparing no sex. It can influence sexual life and reciprocally. Our aims were to study the effects of antiepileptic drugs on the sexual lives of women with epilepsy, the influence of these drugs on pregnancy and breastfeeding. METHODS: We conducted a prospective study from 1st March to 31st August 2011 in the neurological department of the Fann-Dakar teaching hospital Senegal. Only women with epilepsy were included. RESULTS: We collected 120 patients aged 16-64years with a mean age of 30.58years, 45% married, 44.16% were uneducated preponderant. All patients were taking antiepileptic drugs, 89.16% was alone. Fifty-five percent of our patients had epilepsy for at least 6years; 45.83% had generalized epilepsy; 44.17% of partial seizures. In our cohort, 64.16% were under phenobarbital, 69.16% had good adherence. As side effects of drugs, 90% had sexual problems. Seventy-five percent enjoyed an active sex life. A decrease in the number of sex per week for the disease [31/55=56.66%] was noted. In addition, 51.17% were using contraception, including 38.7% of oral kind and 64.86% had noticed an increase in seizure frequency during their pregnancies. Of the 74 women who had contracted a pregnancy, 41.89% had premature infants, 16.21% have made abortions and 61.17% had psychosocial life affected. DISCUSSION AND CONCLUSION: People with epilepsy often experience sexual problems that may be caused by epilepsy, antiepileptic and/or reactions of the partner and the other facing the diagnosis of epilepsy.

[Familial congenital hypomagnesemia revealed by neonatal convulsions]. / Convulsions néonatales révélant une hypomagnésémie congénitale familiale.

Congenital hypomagnesemia is a rare disease, with an impact on cognitive and neurological development. We report on three familial cases of congenital hypomagnesemia, two boys and one girl who belong to the same consanguineous family. They all presented neonatal seizures and a psychomotor developmental delay. Cerebral computed tomography showed cerebral atrophy and calcifications in one case and magnetic resonance imaging found predominant cerebellar atrophy in the two other cases. All three patients also had hypocalcemia, hyperphosphoremia, and hypomagnesemia. The parathyroid hormone blood level was low in two cases and normal in the third. One 7-month old patient died. The others received a supplementation of calcium and magnesium, which normalized calcemia, phosphatemia but not magnesemia, which remained low despite high doses. They have both developed cognitive and behavioral impairments.

[Acute disseminated encephalomyelitis after tetanus vaccination of a pregnant woman in Senegal]. / Encéphalomyélite aiguë disséminée après vaccination antitétanique : une observation chez une femme enceinte au Sénégal.

Although neurological complications have been described after tetanus vaccinations, they are rare. The authors report a case of acute disseminated encephalomyelitis (ADEM) in a 28-year-old pregnant woman at a gestational age of 10 weeks, admitted 15 days after a tetanus vaccination, with spastic tetraplegia and sphincter disturbances. Corticosteroid treatment led to partial recovery of the neurological deficit. Differential diagnosis of infectious and demyelinating diseases of the central nervous system is difficult in view of clinical and laboratory aspects of post-vaccination ADEM. Without any specific diagnostic markers, the clinical examination, magnetic resonance imaging and negative etiological findings were key to this diagnosis. Medical staff must bear in mind the possible complications of this vaccine.

[Myelopathy due to Schistosoma mansoni]. / Myélopathie à Schistosoma mansoni.

INTRODUCTION: Neurological complications of schistosomiasis remain exceptional even in hyperendemic area. CASE REPORT: We report a 26-year-old Senegalese man, without past medical history, who was admitted for spastic paraplegia, acute retention of urine, and pain in low back and lower limbs. The final diagnosis was spinal cord schistosomiasis. Diagnosis was based on the endemic context, MRI medullar conus imaging, schistosoma serology in cerebrospinal fluid and blood, and the absence of other cause of myelopathy. Treatment was based on praziquantel, corticosteroids and physiotherapy. The outcome was favorable after a 2-year follow-up. CONCLUSION: Schistosomiasis should be included in the differential diagnosis of myelopathy in patients living actually, or even traveled in the past, in endemic tropical areas.

[Management of neurological emergencies in developing country: example of Senegal]. / Prise en charge de l'urgence neurologique dans un pays en développement : exemple du Sénégal.

Senegal, like many African countries is facing the so-called demographic and epidemiological transition leading to the development of neurological diseases. These diseases dominated by stroke and status epilepticus are public health priorities with a high prevalence, high lethality and high cost of care. These diseases are managed at the department of neurology, Fann Teaching Hospital, Dakar-Senegal (the only one) with a 65 beds capacity. Unfortunately, access care to the clinic is lately associated with human and material resource scarcity. To improve the management of patients at the clinic, it is important to increase resources (human and material), sensitize the population on early access to health services and prevention of risk factors.

Clinical diagnosis of intracerebral haemorrhage: validation of a simple scoring tool in West Africans.

OBJECTIVE: To validate the use of a simple stroke scoring tool in the clinical diagnosis of intracerebral haemorrhage (ICH). DESIGN: Prospective observational study . METHODS: 184 patients with acute stroke were consecutively evaluated within 24 hours of admission with a simple clinical tool- Benin Stroke Score (BSS), designed to diagnose ICH before cranial Computed tomography (CT) scans were done and the results were compared with CT findings as the gold standard. BSS is a simple 3-item tool with a minimum score of 0 and a maximum score of 3.5, that scores age, Glasgow Coma Scale (GCS) and pre-intervention admission diastolic blood pressure on an assigned score of either 0 or 1 and up to 1.5 for diastolic blood pressure. A model was devised and the accuracy was tested on a receiver operated characteristics (ROC) curve. Intra-rater and inter- rater reliability were tested with Pearson's correlation. BSS and CT were compared with kappa statistics. RESULTS: (1) BSS cut-off value of 2.5 and above was positive for ICH with sensitivity, specificity, positive and negative predictive values and likelihood ratio of 70.20%, 89.00%, 74.10%, 87.00% and 6.38 (AUC of ROC curve = 0.847, p < 0.001). (2) The inter-rater and intra-rater reliability coefficients of BSS were, r =0.90, 0.95 and 0.95 (p < 0.001, <0.001 and < 0.001) respectively. (3) BSS agreed with cranial CT findings in 60% of cases (p < 0.001). CONCLUSION: BSS is a simple 3-item tool with a reliable level of accuracy that could be used early after admission in the clinical diagnosis of ICH where neuroimaging is not available.

[Cryptococcal meningitis in children: description of 3 cases]. / Cryptococcose neuroméningée de l'enfant : à propos de 3 cas.

Cryptococcal meningitis is much less common in children than adults. The purpose of this report is to describe 3 cases of cryptococcal meningitis observed in children admitted to the Neurology Department of the Fann University Hospital Center in Dakar, Senegal between July 2003 and November 2008. There were 2 girls whose ages were 8 and 15 years and one 9-year-old boy. All 3 patients presented acute or chronic meningoencephalitis. Diagnosis was based on direct microscopic examination of India ink preparations of cerebrospinal fluid (CSF) showing Cryptococcus neoformans at direct exam. Two patients were immunocompromised including one presenting severe protein-caloric malnutrition and one infected by HIV-1. The third patient was immunocompetent. All 3 patients were treated by intravenous Fluconazole. The immunocompetent boy died after 1 month of hospitalization due to cardiovascular and respiratory insufficiency. Both girls survived with severe neurosensory sequels. Cryptococcal meningitis that is relatively frequent in adulthood may be underestimated in children and should be tested for in any children presenting meningoencephalitis of undetermined cause.

[Meningoencephalitis due to Morganella morganii: a case report]. / Méningoencéphalite à Morganella morganii : à propos d'un cas.

A central nervous system infection due to Morganella morganii is uncommon. We report a case diagnosed at the neurological department of Fann teaching hospital in Dakar, Senegal. A 12-year-old boy was hospitalized for acute meningoencephalitis. The CT scan was normal and the study of cerebrospinal fluid (CSF) revealed cytological and biochemical abnormalities and M. morganii. HIV and syphilitic serologies were negative and blood CD4 lymphocyte count showed 354 per mm(3). The treatment with cefotaxime associated with gentamicin for 6 weeks was successful. The outcome of infection depends on many factors such as the onset and quality of treatment, the virulence of the germ and the status of immune system.

[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.