infarctus latéral bulbaire : à propos de deux cas … · af f i l i a t i o n : [1] ... à propos...

First African Academy of Neurology Conference

ID : 200008

Type de communication : Poster

TITLE : HEADACHES IN CONSULTATION IN THE WORKPLACE IN THE CITY OF OUAGADOUGOU:IMPACT ON THE QUALITY OF LIFE AND THE PATIENT'S PROFESSIONAL PERFORMANCE

Author : Jean Kaboré [1] , Christian Napon [1] , PriscaRolande Bassolé [2]

Affiliation : [1]Neurology Department, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, BurkinaFaso, [2]Neurology Department, Fann Teaching Hospital, Dakar, Senegal

TOPIC : Hot topics in neurological sciences

ABSTRACT : Headaches are a real public health problem. This study describes the impact ofheadaches on quality of life and job performance in a working population in Ouagadougou. This wasa crosssectional descriptive study from April to June 2011, conducted in six workplaces in the city ofOuagadougou and covering 110 workers. Workers with headaches who consulted in health centers ofworkers during the study period were interested. The epidemiology, clinical and impact of headacheswere assessed using HIT6 and MIDAS tests. The prevalence of headaches was estimated at 8%.The average age was 38.5 years old. By correlating the total number of workers in society with thenumber of patient who consulted for headaches, we found 8% of females against 7% for males. Seenthe profile of different companies, headaches were found mainly among laborers (67.3%). Followingthe history and clinical examination of patients, the prevalence of primary headaches was 83.6%against 16.4% for secondary headaches. Headaches with most significant impact on daily life wereobserved respectively for 17.3% and 31.8% in the HIT6 test. The Grade III and IV of disability wererecorded respectively for 21.8% and 9.1% in the MIDAS test. Headaches impose a heavy burden inthe workplace especially for female and laborers. Their adequate care will improve the quality of lifeof workers with headaches for better work performance. Keywords: Headaches, Impact, Quality ofLife, Performance, Workplace, Ouagadougou


ID : 200011


TITLE : INFARCTUS LATéRAL BULBAIRE : à PROPOS DE DEUX CAS DE SYNDROME D’OPALSKIET REVUE DE LA LITTéRATURE

Author : Mohamed Lelouma MANSARE1 [1] , Daniel Massi GAMS1, Ibrahima Mariama DIALLO1,Maha MAKANE1, Ngor Side NDIAGNE1, Fodé Abass CISSE2, Moustapha NDIAYE1, Amadou GalloDIOP1, Mouhamadou Mansour NDIAYE1 [2]

Affiliation : [1]Department of Neurology, Fann National Teaching Hospital , [2](1)Service deNeurologie C.H.N.U de Fann ; DakarSénégal. (2)Service de Neurologie C.H.N.U d’Ignace DEEN ;ConakryGuinée.

TOPIC : Ischemic Stroke

ABSTRACT : Les infarctus latéraux bulbaires attribués à l’occlusion de l’artère de la fossette latéralebulbaire sont rares. Ils représenteraient 1,5 à 3,5% des infarctus du tronc cérébral. Ils seraientresponsables de la souffrance des tissus rétroolivaires homolatéraux et peuvent réaliser lesyndrome d’Opalski. C’est une urgence thérapeutique en raison des possibilités de thrombolyse oud’anticoagulation jusqu’à 12h. L’avènement de l’IRM et de l’Angiographie dans la pratique médicale afacilité leurs identification. Nous rapportons deux observations de manifestations cliniques dusyndrome d’Opalski qui d’écrit l’association du côté ipsilatéral à la lésion : un syndrome deWallemberg, un syndrome pyramidal et/ou celui de Claude Bernard Horner. Elles ont été réaliséesdans le service de Neurologie de l’Hôpital Fann de Dakar au Sénégal. Le premier malade était âgéde 60 ans et avait pour antécédents l’hypertension artérielle et diabète suivis depuis 5ans. Il avaitprésenté son tableau 12h avant son admission. Il résidait à Dakar . La deuxième malade était âgéede 56 ans sans antécédent documenté. Elle avait présentée sur 3 jours, 5 épisodes d’attaquesischémiques transitoires avant son admission. Elle venait de la région de Saint Louis à environ 370Km de Dakar. L’issues cliniques des deux tableaux étaient différentes respectivement : favorable pourle premier cas avec à la sortie, un score de Rankin modifié à 3/6 grâce à la précocité de la prise encharge et défavorable pour le second cas reçu tardivement son score était 6/6. L’IRM réalisée étaitd’un apport capital dans la formulation du diagnostic et avait facilité leurs prises en charge. Ilspouvaient passer inaperçue. Il convient de noter après l’analyse de l’issue clinique de nos deuxmalades que si, le degré de risque encouru dépend de l’association des facteurs de risquecardiovasculaire considéré et du délai de prise en charge, cependant l’évolution peut êtreimprévisible. Mots clés : Infarctus latéral bulbaire ; IRM encéphalique ; Prise en charge précoce.


ID : 200014


TITLE : KNOWLEDGE, ATTITUDE AND PRACTICE OF PRIMARY SCHOOL TEACHERS TOWARDSEPILEPSY IN OMDURMAN, KHARTOUM STATE 2016

Author : Saria Osman ElAmin [1]

Affiliation : [1]University of Khartoum, Faculty of Medicine, Community Medicinedepartment,Khartoum, Sudan

TOPIC : Epilepsy

ABSTRACT : Background Epilepsy has become a rising problem and usually the first signs ofepilepsy are shown in school, and hence teachers are usually the first to notice it. Methods. Crosssectional descriptive institutional study.Over a period of a week 150 questionnaires were distributedamong 15 schools in the area of Abu Siid and South Omdurman, with 10 questionnaires distributed ineach school Results All the teachers who took part in this interview had heard of epilepsy before. Theoverall knowledge evaluation of teachers concerning epilepsy was reasonable with 47% having goodknowledge, 50% having satisfactory knowledge, and only 3% having poor knowledge. Sadly only 15%had taken a training course on how epileptic kids should be managed. Thankfully around 75%acknowledged that epilepsy wasn't contagious and 70% would allow their kids to play with epileptickids, reflecting positive attitude towards epilepsy. Around 40% had good management skillsDiscussion Although there was a generally positive attitude towards epilepsy there were significantdeficiencies in terms of epilepsy management as less than 50% chose the correct management,which makes sense as only a minority had a course on how to manage epileptics. Conclusion Irecommend that schools should offer some kind of knowledge/ assistance in health services andphysicians must ensure that these teachers have sufficient knowledge of epilepsy and should beadequately trained. Also general public education campaigns should be encouraged to make the childfeel less different and more part of the society.


ID : 200036


TITLE : L’éPILEPSIE EN MILIEU SCOLAIRE DANS UN PAYS TROPICAL OUEST AFRICAIN:ENQUêTE AUPRèS DES ENSEIGNANTS DE SAKOIRA AU NIGER ET REVUE DE LA LITTéRATURE

Author : Soumaila Boubacar [1] , Djibrilla B Adjien Adji [2] , Youssoufa Maiga [3] , Hamid Assadeck[4] , Eric O Adehossi [4] , Moumini Harouna [5] , Djibo D Maiga [6] , Kamadore Touré [7] , Moustapha Ndiaye [8]

Affiliation : [1]Centre de Santé Intégré, Sakoira, Tillabéri, Niger , [2]Département de médecine etspécialités médicales, Hôpital national de Niamey (Niger), [3]Service de neurologie, CHU GabrielTouré Bamako, (Mali), [4]Faculté des sciences de la santé, Université Abdou Moumouni, Niamey(Niger), [5]District sanitaire de Tillabéri, Région de Tillabéri (Niger), [6]Faculté des sciences de lasanté, Université Dan Dicko Dankoulodo de Maradi (Niger), [7]Département de médecine préventiveet santé publique, Cheikh Anta Diop University, Dakar, Senegal, [8]Service de neurologie, CHU Fann,Dakar, (Sénégal)

TOPIC : Epilepsy

ABSTRACT : Introduction: L'épilepsie est une pathologie fréquente en milieu scolaire cependantaucune étude au Niger n'a été menée sur la maladie dans ce secteur d’où l'initiative de ce travail afinde déterminer le niveau des connaissances et attitudes des enseignants de campagnes surl’épilepsie. Méthode : Il s’agit d’une étude transversale descriptive allant de mars à septembre 2014et qui a permis d’interroger les enseignants de la commune rurale de Sakoira à travers unquestionnaire prétesté. Résultats : Au total 52 enseignants ont été interrogés dont 36 femmes et 16hommes. Leur âge moyen était de 32 ans. 12% ont avoué n'avoir jamais entendu parler de l'épilepsieet 27% ignoraient les causes possibles d'épilepsie mais seulement 8% estimaient qu'elle était due àune malédiction. Cependant près de la moitié 42% affirmaient que l’épilepsie est une maladiecontagieuse et 27% pensaient que les élèves épileptiques sont victimes de stigmatisation tandis quela majorité 3/4 (75%) des enseignants rattachait l’absentéisme des élèves épileptiques à la fréquencede leurs crises et la moitié (50%) d’entre eux estimaient que l’épilepsie peut diminuer le rendementscolaire. Plus d’un tiers des enseignants 37% affirmaient que l’épilepsie est incurable et 21 %jugeaient que le traitement traditionnel africain était la meilleure option. Conclusion: L’épilepsiedemeure une maladie mystique en milieu scolaire avec une stigmatisation des élèves épileptiquesd’où la nécessité d’organisation de campagnes de sensibilisation dans les pays africains en généralet au Niger en particulier. Mots clés: épilepsie, scolaire, enseignant, Sakoira, Niger


ID : 200037


TITLE : MYELOPATHY IN PREGNANT WOMEN: A CASE OF ACUTE TRANSVERSE MYELITIS ATFANN DEPARTMENT OF NEUROLOGY IN DAKAR (SENEGAL)

Author : Soumaila Boubacar [1] , Kamadore Touré [1] , Ngor S Diagne [1] , Moustapha Ndiaye [1] , Amadou G Diop [1] , Mouhamadou M Ndiaye [1] , Djibrilla B Adji [2] , Youssoufa Maiga [3]

Affiliation : [1]Department of Neurology, Fann National Teaching Hospital, P.O. Box 5035, Dakar,Senegal, [2]Department of Medicine, National Hospital, P.O. Box 238, Niamey, Niger, [3]Departmentof Neurology, Gabriel Touré University Hospital, P.O. Box 267, Bamako, Mali

TOPIC : CNS Inflammatory diseases

ABSTRACT : Acute Transverse myelitis during pregnancy is rare and is lifethreatening for parturientwomen and their pregnancies. We report a case of young Senegalese parturient woman. This is apatient old 20 years, 1 pregnancy, 1 parity, with a history of asthma and gestational hypertension,who presented motor deficit of 04 members with progressive installation on twenty days during apregnancy to term (9 months) from where achieving a scheduled caesarean during labour thatallowed the extraction of a girl with no abnormalities. Then the patient was sent to our neurology’sdepartment of Fann Hospital in Dakar where she was hospitalized for suitable care. The diagnosis ofacute transverse myelitis was retained on clinical evidence of a spinal interruption syndromeconfirmed by Para clinical investigations. The spinal MRI showed extensive hyper intense signal fromC4 to C6. An inflammatory syndrome with CRP at 108 mg and a high CSF protein at 2.07 g/l. Thepatient had received corticosteroids and physical rehabilitation followed by a favourable outcome. Thetetraplegia during pregnancy are rare and compromise progression of the latter hence the need tolook for spinal suffering signs to objectify etiology which appropriate management depends on.


ID : 200039


TITLE : A RARE CAUSE OF CEREBRAL VENOUS SINUS THROMBOSIS: POLYCYTHEMIA VERA.

Author : Sghaier Naima [1] , Rafik Machraoui [1] , Samia Younes [1] , Mohamed Hbib Sfar [1]

Affiliation : [1]Department of Internal Medicine and Endocrinology Mahdia Universitary Hospital–Tunisia


ABSTRACT : Introduction: Polycythemia vera is a clonal disorder of hematopoietic progenitor cells. Itmanifests as an expansion of red cell mass. Cerebral venous thrombosisis a complication of thepolycythemia vera. Case report: A 60yearold man, presented since a week, an occipital headache,vomiting and visual disturbance. Neurological examination showed mental confusion and bilateralpapillary edema at stage 1. Magnetic resonance imaging (MRI) with cerebralAngioMRI demonstratedCerebral venous pan sinus thrombosis. The CSF pressure was high with a normal formula. Initialhemoglobin was 18.2 g / dL with red blood cell count at 6.3 million/microlitre and 60% hematocrit.Patient had splenomegaly on physical examination confirmed by abdominal ultrasound. Weeliminated the secondary causes of this polycythemia and the screeningof the mutation JAK2V617Fis underway. The diagnosis of polycythemia vera was retained according to the revised criteria “WHO2008”. The patient was treated with iterative bleeding once a week with anticoagulant therapy. Animprovement of the intracranial hypertension syndrome and haematological parameters was obtainedafter few weeks. Discussion: The last few years have witnessed important advances towards anaccurate early diagnosis of polycythemia vera, greater understanding of its pathogenesis, andimproved patient management. The symptomatology of this myeloproliferative syndrome shows agreat similarity with the intracranial hypertension syndrome and can delay the diagnosis of cerebralthrombophlebitis. The presence of ophthalmological signs should encourage the realization of brainimaging. Conclusion: Cerebral venous thrombosisis a rarely revealing presentation of polycythemiavera. Early diagnosis improves the prognosis and reduces the morbidity and mortality of thiscondition.


ID : 200040


TITLE : NIEMANNPICK DISEASE TYPE C: A CASE REPORT


Affiliation : [1]Department of Internal Medicine and Endocrinology Mahdia Universitary Hospital–Tunisia

TOPIC : Other

ABSTRACT : Introduction: NiemannPick disease type C (NPC) is a rare, panethnic, autosomalrecessive neurodegenerative disease. The prevalence of NPC in early life is probablyunderestimated, owing to high fatality rates and the wide clinical heterogeneity of the disease. Casereport: A 26 year old woman without family pathological history, presented at the age of 6 yearspsychomotor deterioration, epilepsy and staturoponderal delay. Seizures were not controlled withmultiple antiepileptic drugs. Neurological examination detected a moderate cerebellar ataxia, verticalsupranuclear ophtalmoplegia, dysphagia, deep mental delay, muscular atrophy and areflexia in lowerlimbs. She has a facial dysmorphies, cervical bilateral polylymphadenopathy and splenomegaly.Biological studies detected a pancytopenia with disturbance in cholesterol assessment. Thoracic andabdominal CT scan demonstrated multiples lymphadenopathies above and below the diaphragm.Lymph node biopsy found lipid surcharge. The conjunction of neurologic signs with systemic signsand the histologic finding are very suggestive of NPC disease. The patient received symptomatictreatment and anticonvulsivant treatment with moderate improvement of the epilepsy but not theother signs. Discussion and conclusion: NPC is characterized by early progressive neurologicaldisorders and visceromegaly that leads to death at an early age. The clinical spectrum of the diseaseranges from a neonatal rapidly fatal disorder to an adultonset chronic neurodegenerative disease.NPC could be under diagnosed so NPC should be seriously considered, at all ages. Improving theknowledge of the disease appears essential since emerging. Treatments should be more efficientbefore the occurrence of widespread deep brain neurological lesions.


ID : 200041


TITLE : CONGENITAL MYASTHENIC SYNDROMES: STUDY OF TWO OBSERVATIONS ANDREVIEW OF THE LITERATURE.


Affiliation : [1]Department of Internal Medicine and Endocrinology ,Mahdia Universitary Hospital –Tunisia

TOPIC : Neuromuscular Disorders

ABSTRACT : Introduction: Congenital myasthenic syndromes (CMS) are a rare heterogeneousgroup of inherited neuromuscular disorders associated with distinctive clinical, electrophysiological,ultrastructural and genetic abnormalities.Through these two cases we present a review of theliterature, specifying the clinical forms, the genetic features and finally, the therapeutic modalities ofthese rare syndromes. Observations: We report the observation of two children aged 14 and12respectively, born from nonmyasthenic mothers who have presented since the first years withswallowing disorders, fatigue muscular effort, ptosis and bilateral oculomotor paralysis. The generalexamination revealed a long face and an ogival palate in the two children. The diagnosis of congenitalmyasthenia has been brought to the clinical aspect, the negativity of the anti acetylcholine receptorantibodies, the absence of thymic abnormalities, the data of the electromyogram and theneuromuscular biopsy. Discussion: These syndromes present usually within the first year of life withnonprogressive fluctuating fatigueable muscle weakness involving limb, trunk, bulbar, respiratory,facial and extraocular muscles. In contrast to the acquired myasthenic syndromes, antibodies areabsent and there is no response to immunomodulation. However, differentiating between antibodynegative acquired myasthenia gravis and late onset recessively inherited CMS remains a challenge.Congenital myasthenic syndromes (CMS) are often difficult to diagnose. Identification of theunderlying mutation is critical, as certain mutations lead to treatmentresponsive conditions whileothers do not. Conclusion: The molecular pathogenesis of CMS is important for both patients andclinicians in terms of reaching a definite diagnosis and selecting the most appropriate treatment.


ID : 200044


TITLE : L’éPILEPSIE, UN FACTEUR DE RISQUE DE TROUBLES DE COMPORTEMENT DEL’ENFANT à PROPOS DE 39 CAS

Author : Patrice Ntenga [1]

Affiliation : [1]Fann National Teaching Hospital

TOPIC : Epilepsy

ABSTRACT : Introduction : L’épilepsie est un facteur de risque supplémentaire en ce qui concerneles troubles psychotiques chez l’enfant avec une prévalence plus élevée soit, 4 et 9 % des cas, parrapport à la population générale. Objectif : notre objectif était de déterminer la prévalence desurvenue des troubles de comportement chez les enfants épileptiques suivis au service depédopsychiatrie. Méthodologie : Il s’agissait d’une étude rétroprospective des enfants épileptiquesprésentant des troubles du comportement amenés et suivis en pédopsychiatrie au sein de l’hôpitalpsychiatrique de Thiaroye de Dakar pendant une période de deux ans de janvier 2013 au décembre2014 Résultats : Nos études avaient démontré que dans 8% des cas, les enfants vivant avecl’épilepsie développaient un trouble de comportement. Les crises généralisées tonicocloniquesreprésentaient 59% des cas. Discussion : La prévalence que nous avons observée corroborait lesétudes d’Irène et al., surtout chez ceux présentant des crises généralisées tonicocloniques, mais lesexratio trouvé était opposé à celui d’une étude similaire menée par Dravet (1.67 avecprédominance masculine). Conclusion : l’épilepsie chez un enfant, favorise la survenue des troublespsychotiques comparée à la population générale. Les efforts doivent êtres fournis dans la réductionde la prévalence de l’épilepsie pour réduire les troubles psychotique chez ce dernier. Mots clés :épilepsie, troubles de comportement, enfant.


ID : 200050


TITLE : RASMUSSEN ENCEPHALITIS IN TROPICAL AFRICAN

Author : Assogba K [1] , Waklatsi KP [1] , Kombaté D [1] , Balogou AAK [1] , Apetse KM [2] , Diatewa JE [3]

Affiliation : [1]neurology service, university of Lomé Togo, [2]Neurology service, university Togo, [3]neurology sesity of Lomérvice, univer Togo

TOPIC : Epilepsy

ABSTRACT : Introduction Rasmussen’s encephalitis is an inflammatory hemiencephalopathy ofunknown etiology. It leads to progressive deterioration of motor and cognitive functions and drugresistant epilepsy. Objective: To report the first case of this condition with review of the literature.Observation We report a girl and a boy of 4 and 8 years old, followed in pediatrics unit of our tertiaryhospital for focal epilepsy evolving since February 2014. With regard to history, pregnancy anddelivery were uneventful in the girl but complicated by fetal suffering with resuscitation in the boy. Thesymptoms marked by febrile focal epilepsy were begun at the age of 1 month for the boy and 4 yearsfor the girl. After several hospitalizations, the children had presented motor deficits of the righthemibody and a regression of the psychomotor acquisitions and the language. Theelectroencephalographic recordings showed an asymmetry of the background rhythm, associatedwith generalized spikes in the boy, and PLEDs in the girl. The cerebral scan showed significantatrophy of the left cerebral hemisphere and cortical grooves. The boy was put under sodiumvalproate and carbamazepine, and the girl under phenobarbital and carbamazepine at graduallyeffective dose. Treatment was associated to motor rehabilitation and speech therapy. We observed adecrease in the frequency of seizures with an improvement of the deficits in the girl and no effect inthe boy. Conclusion: Rasmussen’s encephalitis is under diagnosed in subSaharan Africa andremains mysterious by the incomprehension of its pathophysiological and etiological mechanism.Keys words: drugresistant epilepsy, Rasmussen’s encephalitis, motor deficits


ID : 200051


TITLE : OPTIC NEUROMYELITIS IN BLACK AFRICA SETTING

Author : Assogba K [1] , Apetse KM [1] , Kombaté D [1] , Waklatsi KP [1] , Belo M [1] , BalogouAAK [1]

Affiliation : [1]Neurology service, university Togo


ABSTRACT : Introduction Optic neuromyelitis (NMO), an inflammatory demyelinating disorder of thecentral nervous system, disproportionately affects blacks in mixed populations. In Black Africa, dataon the incidence of NMO are scattered and only a few cases are reported. Clinical report A 26yearold Togolese woman was admitted to our university teaching hospital in June 2016 for a progressivetetraplegia. With regard to the medical history, she had presented an episode of progressive andregressive tetraplegia without sequelae about a year ago. On examination, there was a flaccid fourlimbs deficits with a bilateral Babinski sign, polymodal hypoesthesia with sensory level higher than C4C5 height, respiratory distress without pulmonary abnormalities finding in auscultation, bladder globe,and 39°C of fever. MR showed an extensive intramedullary hypersignal from C2 to C7.Ophthalmologic examination retained bilateral retrobulbar optic neuritis. The search of antiAQP4antibodies was positive. The patient was died by a recurrence of respiratory distress despite highdoses of corticosteroids treatment and physical therapy. Discussion: The French Antilles mostly ofBlack African origin have the highest incidence rates of NMO in the world. Knowledge of the incidenceof NMO in Black African populations would allow a better understanding of the role of genetic andenvironmental factors in the occurrence of this disease. Conclusion: The NMO remains the diagnosisto be first mentioned in front of any extensive myelitis with eyes nerves involvement even in blackAfrica where epidemiological studies on this pathology are not available and management tools areinexistent. Keys words: optic neuromyelitis, medullary syndrome, Africa


ID : 200052


TITLE : A BUTCHER PORK PRODUCER MENINGITIS IN LOW HYGIENE SETTING

Author : Assogba K [1] , Apetse KM [1] , Diatewa JE [1] , Balogou AAK [1] , Salou M [2] , David M[2]

Affiliation : [1]Neurology service, university, [2]Laboratory of bacteriology, University of Lomé

TOPIC : Infectious diseases

ABSTRACT : Introduction The bacterial meningitis due to animal parasites is rare. The objective wasto report uncommon case of animalhuman communicable disease. Case report A 32yearold youngadult carpenter man was admitted for severe headaches and intense agitation in the neurology unit ofour tertiary hospital. The patient is previously healthy with unremarkable medical history. He has beentransferred from a district hospital for better management of vomiting, fever, and chills that begin 72hours ago. At the time of admission, the body temperature, general and consciousness states, andthe neurological examination were normal. At the second day of admission, he felt cold with fever38.5°C, agitation, and severe headaches and vomiting. The neck becomes stiff with Kernig andBrudzinski positive signs. The diagnosis of bacterial meningitis was suggested. Laboratory results ofCSF had shown increased lymphocytes count, an increased of protein concentration at 1.8g/l, andglucose level of 0.47g/l. CSF culture grew small alphahemolytic colonies on sheep blood agar plates.The microorganisms were identified as Streptococcus suis serotype I by VITEK 2 grampositive cardsystem, sensitive to penicillin. The treatment was adjusted to sensitive drugs. After twenty one days offollow up, all the meningeal signs were stopped and the patient had good recovery with bilateral lowhearing acuity. Conclusion: Streptococcus suis meningitis is uncommon communicable disease inhuman. Its most infections occur in older men and children patients who get contact with pigs oreating undercooked pork products or lack of environment hygiene. Keys words: Bacterial meningitis,meningeal syndrome, streptococcus suis


ID : 200055


TITLE : ABCèS INTRAMéDULLAIRE RéVéLé PAR UNE PARAPLéGIE SPASTIQUE CHEZ UNNOURRISSON DE 15 MOIS : à PROPOS D'UNE OBSERVATION

Author : BUGEME M [1] , BELARABI L [1] , NAHANTCHI A [1] , NDONG E [1] , MOURABIT M [1] , TOURE K [1] , NDIAYE M [1] , NDIAYE M M [1] , THIAM A [2]

Affiliation : [1]Clinique de Neurosciences I.P.NDIAYE , CHU FANN , Dakar , Sénégal, [2]Clinique deNeurochirurgie Mamadou Gueye , CHU FANN , Dakar , Sénégal


ABSTRACT : L’abcès intramédullaire est une localisation exceptionnelle. Il pose souvent unproblème diagnostique. L’IRM est fortement indispensable, et permet un diagnostic précoce. Lesauteurs rapportent une observation d’un nourrisson de 15 mois admis pour déficit moteur desmembres inférieurs d’installation progressive dans un contexte fébrile et chez qui l’examen clinique aretrouvé une paraplégie spastique, une cyphose du rachis dorsal avec légère tuméfactionhyperchromique, entourée d’une pilosité en regard des dermatomes T3T4, faisant suspecter unsinus dermique. L’IRM médullaire a révélé un processus pseudotumoral et un tractus faisantcommuniquer la lésion collectée à la peau. Une intervention neurochirurgicale a été réalisée et aconfirmé l’existence du sinus dermique faisant communiquer la peau à l’espace médullaire à traversun cordon ; ainsi qu’un abcès intramédullaire qui a été drainé et dont la culture a isolé leStaphylococcus aureus. Après chirurgie et antibiothérapie, l’évolution a été satisfaisante avec unerécupération partielle de la force musculaire. Mots clés : Abcèsintramédullaire sinus dermique Dakar


ID : 200056


TITLE : CAVERNOUS SINUS THROMBOSIS: ONE CASE REPORT

Author : MOURABIT S [1] , MAKANE M [1] , GAMS MASSI D [1] , BUGEME M [1] , NDIAYE M [1] , NDIAYE M M [1]

Affiliation : [1]Clinique de Neurosciences Ibrahima Pierre NDIAYE , CHU FANN , Dakar , Sénégal


ABSTRACT : The cavernous sinus thrombosis (CST) is a rare condition and often of infectiouscause. The EarNoseThroat (ENT) and dental infections are the main etiologies. We report a case ofCST in a 30yearsold man received at the neurosciences department of Dakar. He was admitted inhospitalization one month after a dental extraction for periapical infection with the main complaint ofexophthalmos, diplopia, palpebral edema, ptosis, hyperesthesia on the right side of the face and araise intracranial pressure syndrome. Brain CTscan and MRI have showed heterogeneous temporallesion with extension to the orbital apex, the superior orbital fissure, the pituitarysellar region andwhich is filling the homolateral interne carotid and cavernous lodge. Etiological investigations haveshowed a biologic inflammatory syndrome (VS: 17 – 44, CRP: 34mg/l). The patient was treated withanticoagulants, broad spectrum antibiotics, painkillers and corticosteroid. The evolution was markedby the regression of the ptosis, the exophthalmos, and the palpebral edema in two weeks, howeverwe noticed the persistence of the hemi facial hyperesthesia and right monocular blindness assequelae. The diagnosis of CST was hold. CST is a rare and severe condition which should beconsidered as diagnostic and therapeutic emergency. Keywords: Thrombosis, cavernous sinus,dental extraction


ID : 200057


TITLE : RISK FACTORS OF BIRTH ASPHYXIA AND SUBSEQUENT NEWBORN MORTALITY INMISURATA CENTRAL HOSPITAL, LIBYA

Author : Maryem Elbashir Ismail [1]

Affiliation : [1]Mohamed Abdelmalek, 1 AbdelAzeem A. M.² Mosratah Libye

TOPIC : Other

ABSTRACT : ABSTRACT Background: Birth asphyxia(B.A) is an important cause of neonatalmorbidity and mortality worldwide, with approximately 4 million asphyxiated babies and 2 millionneonatal deaths each year. Objectives: to identify antepartum, intrapartum, and fetal risk factors of(B.A) and their effect on neonatal survival. Methods: A crosssectional study was conducted on 286neonates with birth asphyxia in neonatal intensive care unit of Misurata Central Hospital, Libya. Weretrospectively analyzed the hospital records from August 2015 to July 2016. Data include: babies’and mothers' demographics; antepartum, intrapartum, and postpartum risk factors; APGAR scores;and neonatal survival. Results Majority of cases are fullterm (71%), of normal birth weight (68.9%)followed by preterm (26.9%) of low birth weight (27.6%). Most cases are borne to mothers deliveredby CS (59.4%), aged 2025 years (32.9%), who were primigravid (59.4%) and (33.9%) of themreported irregular antenatal checkup. Nonsurvivor neonates represent (20.3%) with APGAR scoressignificantly lower than those of survivors. The most prevalent antepartum risk factors are maternalanemia, irregular antenatal visits and toxaemia of pregnancy (38.1%, 33.9% and 10.8% respectively)and intrapartum risk factors are meconium stained amniotic, prolonged labor, multiple pregnancy andmalpresentation (16.4%, 13.3%, 11.2% and 11.2% respectively) with significant higher neonataldeaths among girls (93.1%), preterm babies (46.6%) and babies with acidosis (22.4%). Conclusion:Majority of antepartum, intrapartum, and fetal risk factors studied were founded to play a role in birthasphyxia. Measures should be taken through means of good antenatal and perinatal care. Keywords:Birth asphyxia, Risk factor, Survival, Neonate


ID : 200058


TITLE : COGNITION ABILITIES AND DAILY LIFE FUNCTIONING OF HIV SUBJECTS UNDERANTIRETROVIRAL THERAPY.

Author : Guy Bumoko MD1 [1] , Robert Mussa MD1 [1] , MarieThérèse SOMBO [1] , TharcisseKayembe [1]

Affiliation : [1]1Neurology department, University of Kinshasa, République Démocratique du Congo


ABSTRACT : Objectives: To assess the impact of front line HIV antiretroviral drugs on cognition anddaily functioning of HIV subjects. Subjects and Methods: Neuropsychological evaluation of 200 HIVsubjects (age 40.6 ± 10.6 years, mean nadir cd4 185.9 ±179.9/ml, and duration of infection ranging 2to 18 years). The evaluation was carried out with the HIV dementia (HDS) and the instrumentalactivities of daily living (IADLs) scales. Subjects under highly neuroactive drugs were compared tothose treated with poorly neuroactive drugs as per their central nervous system penetrationeffectiveness scores. Statistical analysis was performed using a logistic regression analysis at thesignificance level of 0.05. Results: The level of education, occupation, nadir cd4, and the type oftreatment regimen were significantly associated with the degree of cognitive impairments (p < 0,01).Subjects under poorly neuroactive drugs and cognition deficits were more likely to be dependent intheir daily functioning, mostly with regards to adherence to treatment regimen (p < 0,01). The oddsratios of being under poorly neuroactive drugs or having impaired cognition were 3.4 (95% CI: 1,2 43,3) and 11.8 (95% CI : 2.47 – 28.08) with respect to functional dependency; or 2,8 (95% CI : 1,11 –7,15) (p < 0,01) for poorly neuroactive drugs after adjusting for treatment regimen. Conclusion: Poorlyneuroactive HIV antiretroviral drugs are associated with poor cognition, dependency in dailyfunctioning of subjects, and risk for nonadherence to treatment. These findings need to be integratedwith global health policies to control the HIV pandemic.


ID : 200060


TITLE : LOWER SERUM LEVELS OF SELENIUM, COPPER, AND ZINC ARE RELATED TONEUROMOTOR IMPAIRMENTS IN CHILDREN WITH KONZO

Author : Guy Bumoko [1]

Affiliation : [1]department of neurology university of Kinshasa Rpublqiue Dmocratique du Congo


ABSTRACT : We assessed the relationship between key trace elements and neurocognitive andmotor impairments observed in konzo, a motor neuron disease associated with cassava cyanogenicexposure in nutritionally challenged African children. Serum concentrations of iron, copper, zinc,selenium, and neurotoxic lead, mercury, manganese,cadmium, and cobalt were measured in 123konzo children (mean age 8.53 years) and 87 nonkonzo children (mean age 9.07 years) usinginductively coupled plasma mass spectrometry (ICPMS). Concentrations of trace elements werecompared and related to performance scores on the Kaufman Assessment Battery forChildren,edition for motor 2nd edition (KABCII) for cognition and Bruininks–Oseretsky Test, 2ndedition (BOT2) for motor proficiency.Children with Children with konzo had low levels of selenium,copper, and zinc relative to controls. Selenium concentration significantly correlated with serum 8,12isoiPF2αVI isoprostane (Spearman r = 0.75, p b 0.01) and BOT2 scores (r = 0.31, p = 0.00) inchildren with konzo. Elemental deficiency was not associated with poor cognition. Mean (SD) urinarylevel of thiocyanate was 388.03 (221.75) μmol/l in nonkonzo compared to 518.59 (354.19) μmol/l inkonzo children (p b 0.01). Motor deficits associated with konzo may possibly be driven by thecombined effects of cyanide toxicity and Se deficiency on prooxidant mechanisms. Strategies toprevent konzo may include dietary supplementation with trace elements, preferentially, those withantioxidant and cyanidescavenging properties.


ID : 200063


TITLE : SYNDROME DE WALLENBERG : A PROPOS DE DEUX CAS à LA CLINIQUE DENEUROSCIENCES I.P. NDIAYE DU CENTRE HOSPITALIER NATIONAL UNIVERSITAIRE DE FANN àDAKAR.

Author : Belarabi Laïla [1] , Nyassinde Japhari [1] , Gams Massi Daniel [1] , Ngor Side Diagne [1] , Seck B. Lala [1] , Kamadore Toure [1] , Ndiaye Moustapha [1] , Diop Amadou Gallo [1] , NdiayeMouhamadou Mansour [1]

Affiliation : [1]Neuroscience Department I.P. Ndiaye, University Hospital Fann, Dakar


ABSTRACT : L’infarctus latérobulbaire ou syndrome de Wallenberg est fréquemment due à uneocclusion de l’artère vertébrale et/ou de l’artère cérébelleuse postéroinferieure, les manifestationscliniques dépendant de l’étendue de l’infarctus. Nous rapportons les cas de deux patients, l’un âgé de46 ans, hypertendu irrégulièrement suivi et l’autre âgé de 60 ans, hypertendu sous Indapamide etdiabétique sous régime, admis à la Clinique de Neurologie du Centre Hospitalier NationalUniversitaire de Fann respectivement en Mars et Avril 2015. Ils ont présenté de façon brutale untableau combinant vertige, syndrome cérébelleux, paralysie du IX et du X, hypoesthésie de la face ducôté de la lésion et une hémihypoesthésie controlatérale à la lésion faisant évoquer un syndrome deWallenberg. L’IRM encéphalique réalisée chez les deux patients a mis en évidence un infarctuslatérobulbaire droit et gauche respectivement. Les bilans étiologiques ont révélé dans les deux casune thrombose de l’artère vertébrale. Les patients ont bien évolué sous traitement à base d’antiagrégeant plaquettaire, d’antihypertenseur, de statine et de kinésithérapie. Le patient diabétique areçu à sa sortie un antidiabétique oral et a été référé en Endocrinologie. Motsclés : Syndrome deWallenberg, Infarctus latérobulbaire, Dakar


ID : 200064


TITLE : SHOULDER PAIN AND GRIP IN HEMIPLEGIC PATIENTS : ABOUT 39 CASES FOLLOWEDAT THE NEUROSCIENCES DEPARTMENT I.P. NDIAYE OF CHNU FANN AND CNAO DAKAR

Author : Belarabi Laïla [1] , Ngor Side Diagne [1] , Ndiaye Mouhamadou Mansour [1]

Affiliation : [1]Neuroscience Department I.P. Ndiaye, University Hospital Fann, Dakar

TOPIC : Other

ABSTRACT : Introduction: The prevalence of shoulder pain in hemiplegic patients is 70% for stroke.It can be favored by glenohumeral subluxation or significant spasticity. This pain, associated withmotor deficit, is at the origin of anomalies of the precision grip. Objectives: Evaluate the precision gripin patients with shoulder pain with vascular hemiplegia. Methodology: All stroke patients lasting forless than 2 years and having shoulder pain, followed for rehabilitation at the CNAO were included andtheir ability to perform life daily activities noted. Precision grip was assessed by the Nine Hole PegTest. The test time was noted, and the characteristics of the pain and its causes. Patients with musclestrength to 0/5 according to MRC were unable to make the Nine Hole Peg Test. Results:39 patientswere recruited, 20 women and 19 men with an average age of 55.18 years. The painful shoulder wasright in 58.9%, and left in 41.1%. 35,8% had a subluxation of the hemiplegic shoulder, 17,9%spasticity, 1 patient had capsulitis and 1 other tendonitis of the rotator cuff. 3 patients had shoulderhand syndrome (7.7%). The pain was neuropathic in 3 patients. The Nine Hole Peg Test wereimpossible in 31 patients, and was performed in 8 patients, with a mean of achieving 2min52 sec. Themuscle strength was quoted at 0 in 24 patients. Conclusion : The shoulder pain in hemiplegic patientsis special by its high frequency. His multifactorial origin appears dominated by the glenohumeralsubluxation and spasticity. Emphasize the importance of prevention by avoiding the glenohumeraldecoaptation.


ID : 200065


TITLE : FRÉQUENCE ET CARACTÉRISTIQUES DES ACCIDENTS VASCULAIRES CÉRÉBRAUXIMPLIQUANT LES ARTÈRES PERFORANTES AU SERVICE DE NEUROLOGIE HUJRBANTANANARIVO MADAGASCAR

Author : RASAHOLIARISON Nomena Finiavana [1] , RAKOTOMANANA Jenny Larissa [1] , RANDRIANASOLO Rahamefy Odilon [1] , RAJAONARISON Lala Andriamasinavalona [1] , RAZAFINDRASATA Ratsitohara Santatra [1] , RAZAFIMAHEFA Julien [1] , ZODALY Noël [1] , TEHINDRAZANARIVELO Alain [1]

Affiliation : [1]Centre Hospitalier Universitaire Befelatanana Antananarivo Madagascar

TOPIC : Spontaneous intra cerebral hemorrhage

ABSTRACT : Les Accidents Vasculaires Cérébraux (AVC) des branches profondes des artèrescérébrales sont surtout des artériolopathies. Ils évoluent vers la démence et la récurrence. Pourmieux prévenir la survenue de ces complications notre étude a pour but d’évaluer la fréquence et lescaractéristiques des AVC des artères perforantes. Une étude rétrospective longitudinale du 01 marsau 25 septembre 2015 fut menée au service de Neurologie CHUJRB. Ont été inclus les patientsprésentant un déficit neurologique brutal et un scanner cérébral avec atteinte du territoire profond.Leurs caractéristiques ont été recueillis. Les données étaient traitées par le logiciel SPSS 20. Quatrevingt trois patients sur 172 AVC (48,25%) avaient des AVC des artères perforantes, avec unepopulation relativement jeune (59,03% âgés de moins de 60 ans, âge moyen : 59,5 ans), àprédominance masculine (61,44%) et hémorragiques intracérébrales (67,46%). Trente et un patients(37,34%) ont présenté des récurrences et plus d'un quart (38,70% ) d’entre eux avaient unerécurrence en moins d’un an. La mortalité était de 6,02%. Mais tous les patients avaient un troubledysexécutif (p = 0,000) et une mauvaise observance thérapeutique d’antihypertenseur au moment dela récurrence. Dans notre étude, les AVC impliquant les artères perforantes touchaient surtout leshommes jeunes, et étaient souvent hémorragiques intraparenchymateuses. Ils étaient peu mortelsmais handicapants à court terme, sur le plan cognitif, lors des récidives. Donc un suivi spécifique enneurologie et en cardiologie est recommandé dès le premier AVC d’artère perforante pour dépisterun début de démence et prévenir les récurrences.


ID : 200067


TITLE : MOVEMENT DISORDERS FEATURES IN WEST SYNDROME CHILDREN: A PROSPECTIVECASE SERIES

Author : Fidelie Scholastique NGOUNGOURE HALIMA [1] , Annick Mélanie MAGNEROU [1] , Moustapha NDIAYE [1] , Mouhamadou Mansour NDIAYE [1] , Corine Vanessa HOTCHO NGANHOU[2]

Affiliation : [1]Neurosciences Department Fann National Teaching HospitalFaculty of MedicineCheikh Anta Diop University, [2]Neurology DepartmentHKM National Teaching HospitalFaculty ofMedicineAbomey Calavi

TOPIC : Parkinson's disease and related disorders

ABSTRACT : Purpose: To describe the clinical, therapeutic and outcome features of movementdisorders (MD) observed in children with West Syndrome (WS) at the Neurology Department of theFann National Teaching Hospital in Dakar. Patients and Methods: This was a prospective studyconducted from October 2015 to December 2016. All of our WS outpatient clinic and followed upregularly for at least 12 months were included. Age at consultation, clinical, neuroimaging, therapeuticand outcome data were collected. Results: A total of 14 children with WS were enrolled and 4 of themwere diagnosed with MD. The mean age at diagnosis was 11 months (range 613) with a sex ratio of1. The type of MD observed were: chorea (1), athetosis (1), axial dystonia (2). No family history ofMD was found. Brain computed tomography showed: diffuse cerebral atrophy (4), thalamiccalcifications (1), multicysts encephalomalacia (2), mega cisterna magna (1). WS was symptomatic inall the children. Drugs used to control MD were diazepam and/or haloperidol. All of the children havereceived physiotherapy. Overall, the outcome of MD was poor in the 4 children. Conclusion:Movement disorders were found in these children with WS and their outcome was poor. Key Words:Movement disorders Children Senegal Disclosure: nothing to disclose


ID : 200072

Type de communication : Oral

TITLE : PREVALENCE AND SEVERITY OF RESTLESS LEG SYNDROME IN THE FES REGION

Author : Siham Bouchal [1] , Imane Rahmouni [1] , Aouatef Midaoui [1] , Zouhayr Souirti [1] , Mouhamed Faouzi [2]

Affiliation : [1]CHU HASSAN II FEZ, [2]Belahsen


ABSTRACT : Background: Restless leg syndrome (RLS) is a chronic neurological sensorimotordisorder, manifested by unpleasant sensations in the legs urging the affected subject to move whichaffects the quality of life and sleep negatively. Prevalence estimates vary between 7,2% and 11,5% ofthe Caucasian adult population. Method: crosssectional study with descriptive and analytical purposein 500 subjects, the aim of which is to define the prevalence of RLS in subjects presenting at theMedical consultation center of the university hospital of Fez in Morocco as consultants or asAccompanying persons. As well as defining the different risk factors and determinants of the disorder,and evaluate the impact of the pathology on the quality of sleep of the affected subjects. Our studywas based on a questionnaire specifically designed for the latter, including the diagnostic criteria ofRLS (IRLSSCG). Patients screened by the questionnaire were referred to an expert neurologist forconfirmation. Once the diagnosis is confirmed, two international scales: severity scale (IRLSSCG) andEpworth scale are administered to the patient. Results: 500 subjects responded to the questionnaire.The mean age was 44.45 years (18 and 80 years) with a clear female predominance 32 subjectswere suspected of having RLS by the questionnaire. The 32 subjects were sent to the specialist forconfirmation. 23 of the 32 were retained positive. 8 subjects out of the 9 not selected have differentialdiagnoses of RLS, the remaining subject was died before specialist confirmation. The prevalence ofRLS was 4.6%. The univariate analysis showed that the consultants had more RLS than theAccompanying patients (p = 0.08). No statistically significant relationship was found with anemia (P =0.18), renal insufficiency (P = 0.164), hypertension (P = 0.112). Conclusion: RLS is frequentneurological disorder. The various epidemiological studies highlighted the ignorance and poormanagement of RLS.


ID : 200074


TITLE : ISCHéMIE BITHALAMIQUE PAR OCCLUSION DE L’ARTèRE DE PERCHERON D’ORIGINECANNABIQUE : à PROPOS D’UN CAS

Author : Traoré Abdoulaye Mamadou [1] , El Mouden Hafida [1] , Kissani Najib [2]

Affiliation : [1]Résident CHU Mohamed VI, Marrakech, Morocco, [2]Professeur CHU Mohamed VI,Marrakech, Morocco


ABSTRACT : Introduction Un accident vasculaire cérébral est le plus souvent provoqué par uneocclusion artérielle responsable d’une ischémie ; on parle d’infarctus cérébral (IC) ou d’accidentischémique transitoire (AIT). La consommation du cannabis est fréquemment associée aux infarctuscérébraux. L’occlusion de l’artère de percheron d’origine cannabique reste peu décrite dans lalittérature. Nous rapportons un cas inédit d’infarctus cérébral par occlusion de l’artère de percherond’origine cannabique. Observation Patient de 25 ans, connu toxicomane au cannabis admis auxurgences 12 heures après la consommation excessive du cannabis, dans un tableau de trouble deconscience d’installation brutal. L’examen neurologique a objectivé un syndrome confusionnel et uneirritation tétra pyramidal. Une IRM encéphalique réalisée a montré des lésions en hyposignal sur laséquence T1, en hypersignal sur la pondération T2 et flair au niveau bithalamique d’allure vasculairefaisant évoqué un infarctus cérébral par occlusion de l’artère de percheron. Complété parl’artériographie cérébrale, qui a confirmé l’occlusion de l’artère de percheron dans sa portionterminale. Un bilan exhaustif d’accident vasculaire cérébral du sujet jeune réalisé est resté nonconcluant. Le dosage de cannabinoide n’a pas pu être effectué. L’évolution a été favorable après 10jours d’hospitalisation sous antiagrégant plaquettaire et surveillance clinique. Discussion et conclusion: la consommation du cannabis est fréquemment responsable de l’infarctus cérébral surtout chez lessujets jeunes. Les mécanismes physiopathologiques sont multiples. Le pronostic dépend d’une priseen charge multidisciplinaire et spécifique. Mots clés : accident vasculaire cérébral artère depercheron cannabis


ID : 200078


TITLE : MECHANICAL THROMBECTOMY FOR ACUTE ISCHEMIC STROKE: INITIAL EXPERIENCEIN UNIVERSITY HOSPITAL HASSAN II AT FEZ (03 CASES)

Author : Benbrahim Fouzia [1] , Bouchal Siham [1] , Mrich Ikram [1] , Toudou Daouda Moussa [1] , Mrani Youssef [1] , Maaroufi Mustapha [1] , Midaoui Aouatef [1] , Souirti Zouhayr [1] , BelahsenMohamed Faouizi [1]

Affiliation : [1]CHU HASSAN II FEZ


ABSTRACT : BACKGROUND: Until recently, intravenous thrombolysis was the only reperfusiontherapy with proven efficacy in patients with acute ischemic stroke. However, this treatment optionhas low recanalization rates in largevessel occlusions. The search for additional treatmentscontinued, whose Mechanical Thrombectomy (MT), combined or not with the thrombolysis, willprobably have targeted results. METHODS: We present our initial experience with 3 cases, allpatients treated for acute ischemic stroke with MT from 09 November 2016 to 20 December 2016.Our study is the first experience of MT in Morocco RESULTS: The 03 patients were men, with amiddle age of 56 years. 02 patients had right hemiplegia, the remaining 01 had a left hemiplegia.Their delays were 150 minutes for one and 180 minutes for 2 patients. All patients benefited from acerebral computed tomography (CT), where the visualization of a spontaneously hyperdense sylvianartery, led us to complete with a cerebral angioscanner which showed a proximal thrombus at thelevel of the sylvian artery contralateral to hemiplegia. 2 patients underwent MT combined withintravenous thrombolysis, one patient had a thrombectomy alone because he has a recent ischemicstroke with hemorrhagic transformation. An overall successful recanalization rate for 02 patients, inthe first case, the NIH score increased from 13 to 4, the second patient recovered completely the lostpoints. The last patient had a malignant ischemic stroke and had a decompressive hemicraniectomy.CONCLUSION: Mechanical thrombectomy seems to be a safe and effective treatment option mostlyin largevessel occlusions. The initial experience demonstrates acceptable efficacy and safety results.


ID : 200080


TITLE : SKULL BASE TUMOR PRESENTING WITH PSYCHIATRIC SYMPTOMS

Author : R.Lansari [1] , T.Lansari [1] , W.Krir [1] , C.Ben Cheikh [1] , H.El Kefi [1] , A.Abdelaziz [1]

Affiliation : [1]psychiatry Departement of psychiatry, Departement of psychiatry, MilitaryHospital/Departement of Neurology Military Hospital, Tunis, Tunisia

TOPIC : Other

ABSTRACT : Introduction: Skull base tumors may not produce symptoms until they grow large. Ifthey do have signs, they vary from person to person depending on where the tumor is and how fast itis growing. Some cases of Skull base tumors may present with psychiatric symptoms. Case report: Inthe present study, we discuss a case of a 62yearold man with no psychiatric history who becomeswithin a month suspicious and starts to speak about conspiracy. He had complaints of markedlydiminished pleasure, loss of energy and decreased appetite. When he complained of otalgia andslurred speech, he was examined by a neurologist. Neurological examination find paralysis of cranialnerves XII, IX and X. MRIs of the brain and bone scintigraphy revealed an infiltrating tumor in themiddle compartment of skull base. Skull Base Biopsy was not conclusive. At that period, he wasadmitted to the psychiatric department for oppositional behavior and apathy. During admission, thepatient was disoriented, with impairment of immediate and recent memory. Rapid and abrupt changesin emotional tone were also observed. All psychiatric symptoms continued worsening despite the useof 2 mg of Risperidone. Discussion: The presentation of patients with diseases of the skull base ishighly variable because of the many important structures contained in this area. Infrequently,psychiatric symptoms may be the first manifestation of skull base tumors. Conclusion: This caseillustrates the need for prompt assessment for brain imaging when patients present with any atypicalpsychiatric symptoms or changes in the mental state.


ID : 200081


TITLE : MULTIPLE SCLEROSIS REVEALED BY BIPOLAR DISORDER

Author : R.Lansari [1] , W.Krir [1] , C.Ben Cheikh [1] , H.El Kefi [1] , A.Abdelaziz. [1] , T.Lansari [2]

Affiliation : [1]psychiatry, [2]neurology


ABSTRACT : Introduction : Multiple sclerosis (MS) is a demyelinating central nervous system (CNS)disease that affects mainly young adults. Emotional disturbances are common in MS. Rarely, MS mayinitially present itself as psychiatric symptoms , similar to that observed in bipolar disorder (BD). Casereport : We report the case of BH a 36yearold single female. By the age of sixteen she wasdiagnosed with bipolar I disorder. Her psychotic symptoms went into remission with the use ofolanzapine and lithum. In 2003, she experienced blurred and double vision. Both of which totallllyimproved spontaneously. In 2005, she developed a subacute motor deficit including her lower limbs,Numbness and a Loss of bladder control. A clinical examination revealed paraparesis andspasticity.The tendon reflexes were brisk on the lower limbs and bilateral Babinski sign was found. Acerebro medullar magnetic resonance imaging (MRI) showed demyelinating lesions mainly in thecorpus callosum periventricular region and cervical cord with Gadolinium enhancement .Autoantibody ( ANA,anticardiolipin and AnCA ) and serology (syphilis, hepatitis B and C, HIV) testswere negative. Analysis of the cerebrospinal fluid (CSF) was normal.The patient was diagnosed withMS. Recovery was obtained with intravenous methylprednisolone and treatment was initiated withNatalizumab considering her psychiatric history. Conclusion: Despite the fact that the higherprevalence of bipolar disorder in MS is well established we still cannot clarify whether this comorbidityimplies a relationship between the two disorders or merely reflects parallel processes of braindeterioration .


ID : 200082


TITLE : UNE ENCéPHALITE LIMBIQUE D’ORIGINE TOXIQUE à TRAVERS UNE OBSERVATION

Author : Elmouden Hafida [1] , Louhab Nissrine [1] , Najib Kissani [1]

Affiliation : [1]Maroc CHU mohamed VI Marrakech Morocco

TOPIC : Other

ABSTRACT : Introduction : L’encéphalite limbique d’origine toxique reste peu décrite. Nousrapportons un cas inédit d’encéphalite limbique secondaire à une prise de toxique. Observation :Patient de 40 ans, admis aux urgences 24 heures après une consommation excessive d’unepréparation toxique (traditionnelle) de nature indéterminée, pour prise en charge d’un état d’agitationmajeure avec trouble de comportement associé à des crises convulsives généralisées. Une IRMencéphalique a été faite en urgence ayant objectivé des anomalies de signal en temporale et eninsulaire bilatérale. Devant le tableau clinique et radiologique une encéphalite limbique a été posée.Le dosage de CPK était élevée à 8 fois la normale faisant suspecté une origine toxique del’encéphalite devant la normalité du reste du bilan notamment : l’étude de LCR, le bilan infectieux,l’ionogramme, les sérologies syphilitiques et HIV qui sont revenues négatives. La recherched’anticorps anti herpes simplex virus IgM et IgG était négative. Les Ac anti récepteur NMDA sontrevenus négatif. Le patient a été mis sous traitement antiépileptique et un traitement sédatif avecbonne évolution clinique 7 jours après. Discussion : Les encéphalites limbiques peuvent présenterdes tableaux cliniques variés. L’origine infectieuse principalement herpétique est la plus incriminédans notre contexte marocain. L’origine toxique a été peu rapportée dans la littérature. Conclusion :Enfin, une anamnèse minutieuse, un bilan étiologique exhaustif et une prise en charge globales’avère nécessaire devant tous cas d’encéphalite limbique. Mots clés : encéphalite limbique, étiologietoxique, paraclinique


ID : 200083


TITLE : LES SYNDROMES CANALAIRES DES NERFS PéRIPHéRIQUES : EXPéRIENCE DULABORATOIRE DE NEUROPHYSIOLOGIQUE, CHU MOHAMED VI DE MARRAKECH.

Author : Elmouden Hafida [1] , Louhab Nissrine [1] , Najib Kissani [1]

Affiliation : [1]Maroc

TOPIC : Other

ABSTRACT : Introduction : Les syndromes de compression nerveuse occupent une place de plus enplus importante dans la pathologie nerveuse. Le but de cette étude est de décrire le profilépidémiologique, clinique, topographique et éléctrophysiologique des patients présentant unsyndrome canalaire au sein du laboratoire de neurophysiologie de Marrakech. Patients et méthodes :étude rétrospective étalée sur une période de 2 ans et 9 mois. Elle a intéressé une série de 172 cas.Nous avons noté les antécédents des patients, les signes fonctionnels d’appel, les données del’examen neurologique et de l’électroneuromyographie . Résultats : Nous avons colligé 172 patientsdont 132 femmes (86%) et 40 hommes (14%). L’âge moyen était de 40 ans. Pour 70 % des cas, lesyndrome canalaire était idiopathique. Les troubles sensitifs ont été retrouvés chez 63 malades. Ledéficit moteur était présent chez 41 patients. Sur le plan topographique, 95% des syndromescanalaires étaient localisés au membre supérieur dominé par le SCC retrouvés chez 136 cas. Unelocalisation aux membres inférieurs n’a été retrouvée que chez 7 patients. L’étudeélectroneuromyographique a objectivé une atteinte sensitive isolée chez 63 malades, 34 maladesavaient une atteinte motrice isolée, tandis que chez 75 cas l’atteinte était mixte. Conclusion : Lapathologie tronculaire doit être bien connue et évoquée. Si des syndromes sont évidents etclassiques (canal carpien, ulnaire au coude) d’autres sont méconnus et font errer des diagnosticspourtant faciles conduisant à des traitements spécifiques bien établis. Mots clé : Syndromescanalaires, Clinique, EMG


ID : 200086


TITLE : ASPECTS EPIDEMIO CLINIQUES ET MORTALITE DES ACCIDENTS VASCULAIRESCEREBRAUX AU SERVICE DE NEUROLOGIE CHU BEFELATANANA ANTANANARIVO

Author : RANDRIANANTOANDRO NALINIAINA ROBERT [1]

Affiliation : [1]NEUROLOGY UNIT OF UNIVERSITY HOSPITAL BEFELATANANA Madagascar


ABSTRACT : La mortalité et la morbidité liées aux AVC restent élevées. L’objectif de notre étude étaitde déterminer leurs aspects épidemio cliniques et le taux de mortalité. Il s’agit d’une étudedescriptive, rétrospective, transversale à l’USFR de Neurologie CHU JRB sur une période de 5 ans,allant de juillet 2011 à juin 2016. Sur les 3380 hospitalisés, 1298 sont admis pour AVC soit 38,40%dont 1272 sont retenus dans notre population d’étude. Le taux d’hospitalisation pour AVC augmentechaque année allant de 30,73% en 2011 jusqu’ à 41,49% en 2016. La tranche d’âge de 40 à 59 ansest majoritaire. Le sex ratio est de 1,03. Ils proviennent de la zone urbaine dans 68,3%. L’ HTA est lepremier facteur de risque identifié touchant 82,7% des patients. Les hémorragies intraparenchymateuses prédominent à 49,60% parmi les patients ayant pu bénéficier du scannercérébral. 20,4 6 % des patients ont eu une récupération totale ou partielle de leur déficit. Le score d’handicap MRS reste moyennement sévère à 4. Le taux de mortalité globale est de 13,36%, réalisantune courbe décroissante de l’année 2011 à 2016. L’identification des facteurs de risque impose uneprise en charge précoce pour prévenir la survenue de l’AVC. Une bonne prévention descomplications de décubitus, la mise en place d’unité neurovasculaire seraient nécessaires pourdiminuer la mortalité


ID : 200087

Type de communication : Conference

TITLE : NEUROCYSTICERCOSIS: A PREVENTABLE CAUSE OF EPILEPSY IN SUBSAHARANAFRICA.

Author : MILLOGO Athanas [1]

Affiliation : [1]CHU Souro Sanou Dioulasso Burkina Fasso


ABSTRACT : Despite its high prevalence, epilepsy is still neglected in many African countries.Neurocysticercosis (NCC) is a possible contributing cause to the elevated prevalence in areas of SubSaharan Africa. Seizures are the primary manifestation of NCC, occurring in about 75% of patientswith imaging evidence of the larval stage of Taenia solium. Thus, identification of persons withseizures is a logical starting point for identification of people with NCC. Estimates of the prevalence ofepilepsy in Africa vary widely. The internationally recognized diagnosis of NCC involves the results ofbrain imaging, serological test to detect antibodies and neurological manifestations. NCC may also bediagnosed by the visualization of a larva in the eye or histological evidence. However, the mostimportant criteria in NCC diagnosis are from the analysis of neuroimages, which has hampered thisdisease from being recognized as a major cause of epilepsy in SubSaharan Africa. The poor accessof the population to neuroimaging facilities limits the availability of representative data on NCC. Inaddition, antibodies detection have proven valid for the diagnosis of exposure to or current infectionwith the larval stages of Taenia solium, but have poor accuracy for the diagnosis of NCC. The mostcommon manifestation of NCC are seizures and epilepsy, and the prevalence of epilepsy has beenshown to be up to 10 times higher in SubSaharan Africa than in developed countries. Educatingphysicians and the community about cutting the life cycle of Taenia solium could contribute toreducing the burden of epilepsy in SubSaharan Africa.


ID : 200089


TITLE : PARAGANGLIOMA EXHIBITING SYMPTOMS OF EPILEPTIC SEIZURES

Author : Kamal E .Siddeg [1] , Abdrahim A dabora [2] , Waleed E Abd rahim [3] , Ammar E MAhmed [4]

Affiliation : [1]Associate Prof. Faculty of Medicine Univ. of Khartoum, [2]S.U.Hospital, [3]AssistantProf. Faculty of Medicine Univ. of Khartoum, [4]Professor/ senior consultant Neurologist/ClinicalNeurophysiologist/ Faculty of Medicine University of Khartoum

TOPIC : Epilepsy

ABSTRACT : Case Report A 16 year –old female presented to our Neurological clinic presenting withrepeated attacks of loss of consciousness, convulsions, head aches and upper abdominal pain.Neurological examination revealed no abnormality. She was fully investigated, ie EEG showed signsof left centrotemporal spikes on occasions appeared generalized in nature. MRI brain did not revealany abnormality. She was put on carbamazepine but still having seizures every four to five months.Her abdominal pain and head aches did not improve. She had been referred to the surgeon who afterperforming CT abdomen did find a mass 4 times 3 cm near the inferior boarder of the pancreas.During surgical exploration and the moment the mass was touched, her blood pressure increasedremarkably to 200 mmHg with the development of supraventricular tachycardia. Catecholamine inurine increased. Histopathology after removing the tumour revealed the diagnosis to beparaganglioma. Post operative follow up was fine. Her seizures were completely abolished duringlong term follow up, ie, so far two years without anti epileptic medication. This case report diddocument occurrence of seizures as a manifestation of chromaffin tumours.


ID : 200091


TITLE : INTERMITTENT FASTING AND CEREBROVASCULAR DISEASES

Author : S. Khellaf [1] , B.S. Fekraoui [1] , A. Boulefkhad [1] , A. Belimame [1] , S. Mennour [1] , K.Kirati [1] , F. Serradj [1] , N. Taghane [1] , H. Semra [1] , Y. Sifi [1] , A. Mzahem [1] , A. Hamri [1]

Affiliation : [1]Department of Neurology, University Hospital Doctor Benbadis, Constantine, Algeria


ABSTRACT : INTRODUCTION: The aim of this work is to evaluate the impact of intermittent fasting(IF) during Ramadan Month on the cerebrovascular diseases. DESIGN/METHODS: A cohort studywas realized on 190 patients admitted for stroke in Neurology Department of Constantine in Algeria.we studied epidemiological factors, prevalence and the strokes severity (NIHSS, mRS, ICH andmortality). It took place from May 18 to August 19, 2015 including three months: Shaaban (beforeRamadan), Ramadan with both groups of patients (having fasted (F) and not (NF)) and Shawwal(post Ramadan). Analysis was done by SPSS20 software. RESULTS: Average age of patients was68.39±16.1 years with a sex ratio of 1,15. During Ramadan: incidence of stroke was lowest andcerebral infarction (CI) were less frequent (38; 80.9% p>0.05). For the F group: Strokes were lesssevere for the F group (NIHSS: 6.13±4.3 and mRS: 2.29±1.0), incidence of intra parenchymalhemorrhage (IPH) and Subarachnoid hemorrhage (SAH) were nil and cerebral venous sinusthrombosis (CVST) frequency was significantly higher (14.3%, p<0.05, OR=4.3) with oralcontraception noted in half cases. The circadian rhythm differed between F and NF groups. Therewas no significant difference in mortality. DISCUSSION: Several literatures data attribute aneuroprotective character to IF. The circadian cycle stroke modification and the increase frequency ofthe CVST during Ramadan are also highlighted. CONCLUSIONS: Our modest study deduces thatduring IF; ICs, IPHs and SAHs are less frequent but mainly less severe. However, and with oralcontraceptives, IF will potentially be a higher risk for CVST.


ID : 200092


TITLE : COGNITIVE IMPAIRMENT IN CHILDREN WITH EPILEPSY AT THIAROYEPEDOPSYCHIATRIC OUTPATIENT CLINIC, SENEGAL

Author : Adjaratou Dieynabou SOW [1] , Anna Modji BASSE [2] , Yannick Fogoum Fogang [2] , Moustapha NDIAYE [2] , Mouhamadou Mansour NDIAYE [2] , Mamadou Moustapha SARR [3] , Kamadore TOURE [3] , El Hadj Makhtar BA [4]

Affiliation : [1]Neuroloy, Fann Teaching Hospital, Cheikh Anta Diop University, DakarTea, [2]Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal, [3]Health UFR, Thies University, Senegal, [4]Psychiatric Department, Fann Teaching Hospital, CheikhAnta Diop University, Dakar, Senegal

TOPIC : Epilepsy

ABSTRACT : Introduction: Epilepsy is a common neurological disorder whose impact on emotionaland cognitive development of children has long been ignored. Methods: We conducted a descriptiveand crosssectional study during 2 months (1 June 31 July 2015) at the Department of childpsychiatry of the National Psychiatric Hospital of Thiaroye (Senegal). We studied the epidemiologicalcharacteristics of cognitive impairment associated with epilepsy in a cohort of 53 childrens. Results:The majority (58%) of children were living in urban areas and 51% were not attending school.Epilepsy predominated among boys (58%) and was most frequent (45.28%) between 11 to 15 years.Generalized tonicclonic seizures had been the most frequent (64.15%) and seizures occurredmonthly in 49.05% of cases. The EEG was abnormal in 67.92% of cases. Clinical history of foetaldistress and familial epilepsy were more frequent, with the syndromic groups of epilepticencephalopathies and epilepsy with awakening seizures. The majority (96.23%) of patients hadn’tbrain imaging. Twothirds of patients had been treated by monotherapy, mainly with sodiumvalproate. Cognitive disorders had been found in 32.07% of patients, starting before seizures onset in13.21% of cases. A progressive speech disorder was present in 26.41% of patients, often appearingbefore 3 years old (13.21%); They were mainly dysphasia or delay in language acquisition.Conclusion: Almost a third of our patients (19 %) had reading difficulties. The most common cause ofdropout from school was represented by hyperactivity. Keywords: Epilepsy cognitive disorders Psychiatry Thiaroye Senegal


ID : 200093


TITLE : BIOLOGICAL PROFILE IN STROKE: A SENEGALESE COHORT IN FANN TEACHINGHOSPITAL

Author : Adjaratou Dieynabou SOW [1] , Anna Modji BASSE [1] , Ngor Side DIAGNE [1] , NdiagaMatar GAYE [1] , Marième Soda DIOP SENE [1] , Alassane DIOP [1] , Amadou Gallo DIOP [1] , Mouhamadou Mansour NDIAYE [1] , Kamadore TOURE [2] , Ousmane CISSE [3] , MoustaphaNDIAYE [4]

Affiliation : [1]Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar,Senegal, [2]Health UFR, Thies University, Senegal, [3]neu, [4]N


ABSTRACT : Introduction: Stroke are diagnostic but also therapeutic emergencies. His preventionneeds a precise etiologic identification, and biology can help for that. This work tried to describe thebiological profile of stroke’s patients with prognostic assessment. Methods: Retrospective crosssectional study of patients hospitalized for stroke at the neurological clinic of Fann in Dakar betweenJanuary and March 2014. Results: We have listed 100 patients with complete medical records.Married and men predominated with respectively 57% and 87%. The average age was 64.7 years(±14.2). History were dominated by hypertension (71%), first stroke (27%), diabetes (14%) and heartdisease (7%). 70% of Strokes were ischemic. ALAT and ASAT rates were higher than normal torespectively 13.25% and 39,75%. Total cholesterol was as high (11%) in womens than mens whileHDL was lowest among womens (36,11%) than for mens (12.75%). The triglycerides rates was highin 86.07% of patients. Hyperglycemia and anemia were respectively observed in 35.4% and 21% ofthe patients. Conclusion: Biological assessment remains essential in the management of STROKE.Major disturbances affected lipid, blood glucose and anemic profile. Keywords: biology, stroke,Neurology, Senegal.


ID : 200094


TITLE : STROKE MANAGEMENT: KNOWLEDGE, ATTITUDES AND PRACTICES OF HEALTHPRACTIONNERS IN MEDICAL DISTRICTS OF DAKAR (SENEGAL)

Author : Adjaratou Dieynabou SOW [1] , Ngor Side DIAGNE [1] , Anna Modji BASSE [1] , MaoulyFALL [1] , Alassane DIOP [1] , Moustapha NDIAYE [1] , Amadou Gallo DIOP [1] , MouhamadouMansour NDIAYE [1] , Kamadore TOURE [2]

Affiliation : [1]Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar,Senegal, [2]Health UFR, Thies University, Senegal


ABSTRACT : Introduction: Stroke is a public health problem due to its frequency, severity and socioeconomic burden. Therefore, good strategies are necessary to reduce stroke morbidity and mortality.Accurate knowledge, attitudes and practices (KAP) from caregivers are crucial for a better strokemanagement. This study sought to determine the KAP of caregivers towards stroke. Methods:Prospective and crosssectional study between May to December 2013 including doctors and nursesfrom 44 health centres of the 4 districts of Dakar (2 millions inhabitants). Data collected, withquestionnaire, were analysed using SPSS 16.0. Results: During the study period, 296 patients withstroke were received in these four health districts. The response rate was 95.45%. Responders werenurses (54.76%), physicians (31%) and midwives (14.29%). To designate stroke, 41.66% ofphysicians and 71.43% of paramedics just used the acronymic term of“CVA” (cerebrovascularaccident). However, one third of physicians and 3.57% of paramedics were closer to the correctdefinition. Unlike paramedics, stroke manifestations are better known by physicians. Physicians andparamedics mostly ignore the mechanisms and types of strokes (intracerebral bleeding or ischemia).Risk factors are well known, especially the triad made of hypertension, diabetes and obesity, reportedby the majority of participants. The first line diagnostic investigation was cerebral tomdensitometry for91.66% of physicians and only 35.3% for paramedics. Conclusion: This study shows a limitedknowledge attitude and practice of caregivers especially for paramedics towards stroke definitions,basis and management. An efficient initial and continuous education program of health practitionerson stroke is warranted.


ID : 200103


TITLE : METABOLIC VARIATIONS, PLACE OF THE HAPTOGLOBINE AMONG EPILEPTICSFOLLOWED TO THE FANN CHUN; DAKAR SENEGAL VARIATIONS MéTABOLIQUES, PLACE DEL’HAPTOGLOBINE CHEZ LES éPILEPTIQUES SUIVIS AU CHUN DE FANN ; DAKAR SENEGAL

Author : Adjaratou Dieynabou SOW [1] , Moustapha NDIAYE [1] , Anna Modji BASSE [1] , MaoulyFALL [1] , Amadou Gallo DIOP [1] , Mouhamadou Mansour NDIAYE [1] , Mamadou MoustaphaSARR [2]

Affiliation : [1]Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar,Senegal, [2]Health UFR, Thies University, Senegal

TOPIC : Epilepsy

ABSTRACT : Introduction: epilepsy is a chronic condition requiring long term medication which canlead adverse reactions and/or biological/metabolic disturbances. This work tried to check changes inlipid parameters that may arise during antiepileptic treatment (AET), and to study the influence of thehaptoglobine (Hp) polymorphism on epilepsy’s development. Methodology: Longitudinal prospectivestudy from October 2012 to December 2013 concerning epileptics followed at least 2 years, undergood dose treatment wellmonitored. These patients were matched with controls healthy, similar onage and sex. Blood samples were taken at rest, on fasting. Data were analyze on Statview software.Results: 38 epileptics and 38 witnesses: 53% of women and predominance of the 2039 years.Epilepsy evolved since 230 years, treated with monotherapy (52.6%), mainly phenobarbital (71%)and Carbamazepine (44,73%) from 2 to 28 years. No significant difference between patients andwitnesses for the blood glucose and HDL cholesterol, but significant rise of total cholesterol, LDLc,triglycerides, urea in epileptics. Significantly greater frequency of seizures with the profile Hp2.2.Discussion: The significant increase in lipid and renal parameters among epileptics during treatmentwould suggest exposure to cardiovascular complications. This phenomenon could be mediated by the2.2 haptoglobine more frequent among our epileptics and sources of more important seizures. Butalso by the blood associated with a reduction in folic acid, homocysteine increase found under TAEextended. Conclusion: Differences in susceptibility among epileptics of variable phenotypes could belinked to functional polymorphism of genes coding for enzymes/proteins including the haptoglobine:open door to cardiovascular complications? Keywords: metabolic variations, haptoglobine, epilepsy,Neurology, DakarSenegal


ID : 200109


TITLE : RISK FACTORS FOR ISCHEMIC STROKE, ABOUT 442 CASES

Author : Mustapha Chaqda [1] , Mohammed Chraa [1] , Najib Kissani [1]

Affiliation : [1]Neurology department University Hospital Mohammed VI, Marrakech Morocco


ABSTRACT : Introduction: Stroke is a personal, familial, and social disaster. It is the third leadingcause of death worldwide, the first cause of acquired disability and the second cause of dementia; itscost is astronomic. The aim of this study was to assess the frequency of ischemic stroke and its majorrisk factors in our context. Patients and methods: Retrospective study from January 2000 toDecember 2010. It focuses on 442 cases of patients hospitalized for ischemic stroke in the NeurologyDepartment in the university hospital of Marrakesh, Morocco. Results: There were 215 men (48.6%)and 227 women (51.4%). The average age was 61 years. It was 60.5 ± 11.07 years for men and 62.5± 13.6 years for women. The prevalence of ischemic stroke in our department was 10.4%.Hypertension was the major and most frequent factor with 42.9%. Tobacco consumption was noted in25.3% of patients. The incidence of diabetes (type 2) was 15.3%. The rate of patients withdyslipidemia was 5.7%. Atrial fibrillation was noted in 30.4% of cases. The recorded death rate was13.4%. Hypertension poorly treated or ignored was the main risk factor for ischemic stroke in ourdepartment. Discussion and Conclusion: This is a first study done in third level Hospital of Marrakesh,focusing on risk factors of ischemic stroke. This study allows us to draw the profile of strokemanagement in our daily practice Hypertension is the most significant modifiable risk factor for stroke.The control of all risk factors as a primary or secondary prevention is the pillar of the management ofstroke.


ID : 200112


TITLE : NEUROMYOPATHY CAUSED BY SYNTHETIC ANTIMALARIAL DRUGS

Author : Marieme Soda DiopSene [1] , Ousmane Cisse [1] , Moustapha Ndiaye [1] , amadou GalloDiop [1] , Mouhamadou Mansour ndiaye [2]

Affiliation : [1]Fann Teaching Hospital, Dakar, Senegal, [2]nFann Teaching Hospital, Dakar, Senegal


ABSTRACT : Abstract: Synthetic anti malaria drugs are effective in the treatment of many autoimmune diseases and principally systemic lupus. Side effects remain rare. The occurrence ofneuromyopathy is rare. Our article reports the case of a women presenting a neuromyopathyprobably caused by antimalarial drugs. The observations of neuromyopathy due to chloroquine areextremely rare. Our observation brings up the problem of toxicity of synthetic antimalaria drugs whichapart from their retinian toxicity can be the cause of neuromyopathies. The association ofchloroquine/hydroquinidine seems potentially more toxic on the neuromuscular plan. Keywords:neuromyopathy, toxicity, synthetic antimalarial drug, chloroquine, hydroquinidine.


ID : 200113


TITLE : MOVEMENTS DISORDERS DUE TO TOXOPLASMA ABSCESS IN PATIENTS WITH AIDS

Author : Annick Melanie MAGNEROU [1] , Yannick Fogang [1] , Victor Sini [2] , Pierre Ongolozogo[3] , Lazare Kaptue [4]

Affiliation : [1]Cheikh Anta Diop University,neurology Department Dakar Senegal, [2]GeneralHospital of Douala Dakar Senegal, [3]Yaounde central Hospital Dakar Senegal, [4]Higher Institute ofHealth Sciences of Dakar Senegal


ABSTRACT : Objective: Evaluate the movements disorders in HIV patient. Background: MovementDisorders may be the result of direct central nervous system infection by human immunodeficiencyvirus (HIV) or the result of opportunistic infections like toxoplasma encephalitis. Methods: It was across‐sectional descriptive study during 3 years, in adult young patient with AIDS followed at Yaoundecentral hospital. Results: In 105 HIV positive patients followed for toxoplasma encephalitis; 3 patients(2,8%) had involuntary movements: one hemichorea/hemiballismus and two hemidystonia. The meanage was 35.3 ± 9.2 years. All were men and HIV 1 was the viral type encountered. The mean CD4 cellcount of the patients was 58.5 ± 46.2/μl. The brain lesions were all heterogeneous with contrastenhancement associated with peripheral edema. The abscesses were multiple in all patients,supratentorial, in the frontal lobes and basal ganglia. Movement Disorders are completely resolvedafter two weeks since starting treatment and disappearance of other associated neurologic symptom.Brain CT scan control showed marked resolution of cerebral lesion. The most encountered treatmentoptions were sulfadiazine‐pyriméthamine in one patient and by Trimethoprim‐sulfamethoxazoleassociated with steroid in two patients. They did not receive dopamine blocker. Conclusions: Reportsof extrapyramidal Movement Disorders in AIDS patients due to toxoplasma abscesses are rare.Toxoplasma encephalitis should be considered in HIV‐positive patients presenting withhemichorea/hemiballism, dystonia associated or not with focal neurologic deficits of progressiveonset, seizures or headache. The CT‐scan showed ring‐enhanced lesion in the basal ganglia.Sulfadiazine‐pyrimenthamine or sulfamethoxazole‐trimethoprim associated with highly activeantiretroviral therapy leads to significant improvement of involuntary movement.


ID : 200114


TITLE : PEJORATIVES FACTORS OF AFRICAN YOUNG PEOPLE ISCHEMIC STROKE: EXAMPLEOF SENEGAL

Author : Ousmane Cissé [1] , El Hadji Makhtar Ba [1] , Marieme Soda DiopSène [1] , MoustaphaNdiaye [1] , Amadou Gallo Diop [1] , Mouhamadou Mansou Ndiaye [1]

Affiliation : [1]Department of Neurology, Fann National Teching Hospital, Dakar,Senegal


ABSTRACT : Introduction: Strokes are frequent and severe, because of the involvement of vital andfunctional prognosis of patients, especially in young patients living in developing countries. Ourobjectives are to identify epidemiological, clinical, paraclinical and etiological predictors of adverseevolution in young adult ischemic stroke. Methodology: We conducted a retrospective study at theneurological department of Fann, (Dakar), on the records of hospitalized patients from 01 January2010 to 31 December 2011. Patients aged from 1555 years in whom the diagnosis of ischemicstroke were selected on the basis of clinical findings and confirmed by a brain scan were included inour study. Results: We gathered 116 cases. Mean patient age was 43.5 years. The main risk factorsfound in medical history of patients were hypertension (57.7%), diabetes (19%), and history of stroke(10.3%). Clinical signs were dominated by hemiplegia (95.7%) and language disorders (61.2%). Theaverage length of stay in hospital was 16 days. A death rate of 28.4% was observed. The mainpredictors of adverse evolution identified were the length of stay in hospital, age, Glasgow ComaScale, blood glucose level. Patients with a GCS lower than 10 had a risk of death multiplied by 5.Patients with blood glucose level ≥ 2 had 4 times greater risk of death than others. Discussion andconclusion: Glucose acute phase and state of consciousness seem to be predictors of cerebralischemia. A quick and appropriate management will improve the vital prognosis and better recovery.Keywords: Ischemic stroke, Young people, pejorative factor.


ID : 200115


TITLE : REDUCED LEVELS OF 25HYDROXYVITAMIN D3 IN TUNISIAN PATIENTS WITH MULTIPLESCLEROSIS: ANOTHER EVIDENCE FOR THE EMERGING ROLE OF VITAMIN D IN MSPATHOGENESIS

Author : FEKI Sawsan [1] , MEJDOUB Sabrina [1] , HACHICHA Hend [1] , MASMOUDI Hatem [1] , NAIFAR Manel [2] , AYEDI Fatma [2] , DAMMAK Mariem [3] , MHIRI Chokri [3]

Affiliation : [1]Immunology Department, Habib Bouguiba UH, Sfax, Tunisia, [2]BiochemistryDepartment, b Bouguiba UH, Sfax, Tunisia, [3]Neurology Department, Habib Bouguiba UH, Sfax,Tunisia


ABSTRACT : Recently, vitamin D (VitD) has become a topic of interest in immune regulation,especially in the context of multiple sclerosis (MS). A substantial evidence base now exists supportingan association between VitD and MS, primarily illustrated by a latitudinal gradient of MS prevalence, amonth of birth effect, an interaction of VitD with MSassociated genes and the fact that high VitDlevels have been associated with a reduced MS risk. The aim of this study is to analyze VitD status inTunisian MS patients and to test the correlation of this parameter with clinical and biological features.This prospective study included 50 patients (38 women and 12 men, mean age: 38 years old) withconfirmed diagnostic of MS (40 Relapsing remitting MS (RRMS) and 10 progressive forms). Patientssupplemented in VitD were excluded. Serum levels of VitD (25hydroxyvitamin D3) were performed byelectrochimiluminescence method (Cobas 6000, Roche®). Statistical analysis was made usingSPSS.20 software. The mean rate of VitD in patients was 8.68 ng/ ml (min=3 ng/ml; max=20,3 ng/ml)with levels <10 ng/ml (severe deficiency) in 64% of patients (93.7% were women). Mean rates weresignificantly lower in women (8.6 ng/ml) than in man (9.7 ng/ml) (p=0.01). Levels of VitD werenegatively correlated with age. Patients with RRMS had a mean rate of VitD (9 ng/ ml) lower thanpatients with progressive forms (12 ng/ ml) (p=0.06). There was no significant difference of VitD levelsbetween groups of RRMS patients regarding the activity of the disease and the presence or not ofIgG oligoclonal bands in CSF. Our results emphasize the emerging role of VitD status in MSpathogenesis, especially in its RR form. Observational studies are increasingly pointing to a reducedlevel of VitD in the blood as a risk factor for developing MS, and experimental studies are underway todetermine if VitD levels influence MS disease activity. Recent research also points to a possible rolefor VitD in neuroprotection and myelin repair.


ID : 200116


TITLE : INFANT EPILEPSY: SENEGALESE COHORT

Author : EL HADJI MAKHTAR BA [1] , Anna Mbodj Bass [1] , Ousmane Cissé [1] , Fatoumata BA [2], Moustapha Ndiaye [3] , Amadou Gallo DIOP [3] , Mouhamadou Mansour Ndiaye [3] , MariemeSoda Diop Sene [3] , Adjaratou Dieynaba Sow [3] , Niaga Matar Gaye [3]

Affiliation : [1]CHNU Fann/Université Cheikh Anta Diop Dakar Senegal, [2]Université Gaston BergerDakar Senegal, [3]Fann/UCAD Dakar Senegal

TOPIC : Epilepsy

ABSTRACT : Introduction : Epilepsy represents a public health problem, especially in developingcountries. Infants are frequently concerned. This study aims to describe the biographicalcharacteristics, phenotypic, and scalable epilepsy in infants. We conducted a retrospective study,from February 2003 to August 2013 at the neurological clinic CHNU Fann and Albert Royer ChildrenHospital in Dakar Senegal. Methods : This study aimed to determine sociodemographic, phenotypicand evolutive characteristics of epilepsy in infants. We conducted a retrospective study from February2003 to August 2013 at the neurology department of Fann Teaching Hospital, and Albert RoyerChildren Hospital in Dakar, Senegal. Results: Mean age of infants was 17 months. A family history ofepilepsy was found in 23% of cases. Mean age at onset of seizures was 8 months. Generalized tonicclonic seizures were found in 50% of cases. Focal motor seizures were noted in 25% of infants.Others types of seizures were found in the remaining cases. Epileptic syndromes were distributed asfollows: 19% of idiopathic epilepsies, 7.4% of febrile seizures, and 73% of non idiopathic epilepsies.Treatment yielded to a cessation of seizures in 66% of cases. Seizures persisted in 23% of infants,and 11% were lost to follow up. Discussion and conclusion : In our setting, infants’ epilepsies arecharacterized by an important electroclinical variability, with considerable difficulties for an optimalmanagement. Keywords: epilepsy, infants, electroclinical variability, cognitive development, Senegal.


ID : 200117


TITLE : SOCIOCULTURAL DIMENSIONS OF EPILEPSY IN A POPULATION (TEACHER OF IVORYCOAST)

Author : Karidioula [1] , Gnazégbo [1] , KouaméAssouan [1]

Affiliation : [1]CHU Bouaké Bouak Cte dIvoire

TOPIC : Epilepsy

ABSTRACT : Sociocultural dimensions of epilepsy in a population (teacher of Ivory Coast) KaridioulaHA 1a , Gnazégbo A1, KouaméAssouan AE1, Akani AF 1 ,Bony KE1 , Sylla A1 1Service deNeurologie CHU de Bouaké /Côte d’Ivoire Summary Epileptic disease is both considered as a divineand mystic affection. Many primary school teachers, guarantors of the education of the children havediifferents views. Our target is to assess the level of knowlegde of ivorians primary school teachersabout epilepsy. method and Materials: This was a prospective, crosssectional study that lasted twomonths. Three inspections of the primary school (IEP) of Bouaké were chosen Results: 304 teacherswere interviewed. 6.98% had a level of undergraduate study and 51.83% other teachers had a levelof study of the second cycle, finally 41.20% had a university level. 81.20% of the teachers interviewedsay they have little information about the disease of epilepsy. For 45.56% of teachers, epilepsy wascontagious. During an epileptic seizure, 47.70% of primary educators thought it was necessary toavoid touching saliva. The prohibition to cook came back in 34.84% and not to eat on the same platewith an epileptic in 46.05%. Some teachers believed that an epileptic can not contract HIV infection in20.32%. For 46 to 56% of the respondents, an epileptic can not be a leader. Conclusion: this studyshowed that the level of knowledge of ivorians primary school teachers about epilepsy is very limited.Keywords: Epilepsyknowledgeaptitudeteachers


ID : 200119


TITLE : HIV INFECTION, HYPERCOAGULABILITY AND ISCHAEMIC STROKE IN ADULTS AT THEUNIVERSITY TEACHING HOSPITAL IN ZAMBIA: A CASE CONTROL STUDY

Author : Zimba Stanley [1] , Atadzhanov Masharip [1] , Lakhi Shabir [1] , Mukomena PatriceNtanda [1]

Affiliation : [1]University of Zambia Zambia


ABSTRACT : INTRODUCTION: In Zambia, 14.2% of adults have HIV/AIDS. There has been asubstantial and significant increase in patients hospitalized for ischaemic stroke with coexisting HIVinfection. The aim of this pilot study was to explore the association of hypercoagulability state inHIV+ve patients with ischaemic stroke. We compared hypercoagulability state markers betweenHIV+ve ischaemic stroke patients with HIVve and HIV+ve patients with and without ischaemic strokerespectively. METHODOLOGY A matched case control study in which a total of 52 HIV+ve patientswith ischaemic stroke were prospectively compared with control groups for the presence of protein S,protein C deficiencies and hyperhomocysteinaemia. The control groups comprised an equal numberof consecutively matched for age and sex HIVve and HIV+ve patients with and without ischaemicstroke respectively. Data was analysed in contingency tables using Paired t test, Chi square andconditional logistic regression. RESULTS Ischaemic stroke of undetermined aetiology occurred morefrequently in HIV+ve compared to HIVve patients (p<0.001). In addition, protein S deficiency andHyperhomocysteinaemia were more prominent in HIV+ve than HIVve ischaemic stroke patients(P=0.011). There was no difference in the presence of hyperhomocysteinaemia or protein Sdeficiency in HIV+ve patients with or without ischaemic stroke. CONCLUSION Protein S deficiencyand hyperhomocysteinaemia were strongly associated with HIV infection, but not stroke in our studypopulation. However, this is an area that requires extensive research and one that we cannot affordto ignore as it is an important bridge to all cardiovascular and cerebrovascular diseases.


ID : 200121


TITLE : SPONTANEOUS EVOLUTION OF HYPERTENSION OF 1ST DAY TO 5TH DAY DURING ASTROKE IN NEUROLOGY DEPARTMENT HUBEFELATANANA

Author : RAZAFINDRASATA Santatra [1] , RANDRIANASOLO Odilon [1] , RAJAONARISONAndriamasinavalona [1] , TEHINDRAZANARIVELO Alain [1] , RAZAFIMAHEFA Julien [2]

Affiliation : [1]Faculty of Medicine in University of Antananarivo Madagascar, [2]Faculty of Medicinein University of Antananarivo Madagascar


ABSTRACT : Introduction : Hypertension represents about 50% of the risk of onset of stroke. It iscommon during the acute phase of stroke need supervision and care in stroke unit (UNV). Tomaximize this support, we wanted to describe hypertension develops during the acute phase ofstroke. Methods : A retrospective descriptive study was performed in the Neurology HospitalUniversity (HU)Befelatanana between April and June 2015. We included all patients with a suddenneurological deficit with or without scanner, and a systolic blood pressure > 150 mmHg and / ordiastolic blood pressure > 100 mmHg from 1st day (D1). Blood pressures from D1 to D5 (5th day)were collected. Data were proccessed by Epiinfo 7. Results : Thirtyseven patients (49.33%) werehypertensive from first one day on 75 stroke admitted during these 3 months. The average age ofonset was 57.75 years with a predominance of women and ischemic stroke (43.24%). Of these 37patients, 89.19% are known hypertensive, the 13.51% had died before D5 and 78.38% had bloodpressure fluctuations during the day. The average blood pressure (ABP) was high especially in thefirst 34 days and begins to spontaneously decrease from the 5th day with ABP to 114 mmHg.Conclusion : Hypertension during the acute phase of stroke is common, predictable, low, fluctuatingthroughout the day, high in the first 34 days to spontaneously fall from D5. A regular checkgoing andpersonalized care are needed to prevent serious complications. Keywords : Acute stroke,hypertension, Neurology HUBefelatanana, stroke


ID : 200124


TITLE : EPIDEMIOLOGICAL STUDY OF EPILEPSY AT NEUROSCIENCES AND MENTAL HEALTHLABORATORY (LNSM) OF ANTSAKAVIRO: A 2 YEARS STUDY

Author : RAVELOSAONA Fanomezantsoa Noella [1]

Affiliation : [1]Hospital Befelatanana Antananarivo

TOPIC : Epilepsy

ABSTRACT : TITLE: EPIDEMIOLOGICAL STUDY OF EPILEPSY AT NEUROSCIENCES ANDMENTAL HEALTH LABORATORY (LNSM) OF ANTSAKAVIRO: A 2 YEARS STUDY NoellaFanomezantsoa Ravelosaona, Ratsitohara Santatra Razafindrasata, Nomena Rasaholiarison, JulienRazafimahefa, Alain Djacoba Tehindrazanarivelo Introduction: Epilepsy is the most frequentneurological disease in the world estimated at about 50 million and almost 80% of them are found indeveloping countries like Madagascar. Our objective is to evaluate the demographic characteristics ofepilepsy in a reference center that performs clinical and paraclinical deep analysis of issues such asNeurosciences and Mental Health Laboratory of Antsakaviro over a period of 2 years and comparethem with more data nonspecific centers by direct standardization method. Methods: This is aretrospective descriptive study in LNSM of Antsakaviro over a period of 24 months from January 2013to December 2014 with specific direct standardized prevalence of age, two populations with areference population. Results: The crude prevalence rate of epilepsy in 2013 is equal to 572 per 1000while in 2014 it was 698 per 1000/ year seen at LNSM and 15%o in the population for nonspecificdiagnostic centers 22 regions. With standardized rate compared to the age of 345% and 14.81%o in2013 and 204%o and 15.38 in 2014. The crude incidence in 2013 is 49988 to 100000 persons / yearand its value in 2014 is equal to 50,775 to 100,000 people / year. Conclusion: Despitestandardization, the prevalence and crude incidence of epilepsy were higher than in the literature.Keywords: Epilepsy, incidence, prevalence, direct standardization.


ID : 200126


TITLE : WEIGHT GAIN TO EVALUATE EFFECTIVE EPILEPSY TREATMENT AMONG CHILDRENUNDER 5 YEARS OLD IN DEVELOPING COUNTRY SETTING

Author : Randrianasolo Rahamefy Odilon [1] , Rasaholiarison Nomena [1] , Razafimahefa Julien [1] , Tehindrazanarivelo Alain Djacoba [1]

Affiliation : [1]Faculty of medecin Antananarivo

TOPIC : Epilepsy

ABSTRACT : Introduction; Seizure attack monitoring in children under 5 years old with epilepsy isdifficult to assess in our country where most of parents are under instructed. Weight monitoring havebeen proved to be easy to use and accurate to assess good health and good physical developmentamong children. We decided to evaluate the feasability and accuracy of using weight monitoringinstead of seizure attacks monitoring to evaluate and monitor epilepsy treatment in children. Methods:We performed a cohort study of newly diagnosed epileptic children treated at the Laboratory ofNeuroscience and Mental Health Antsakaviro, Madagascar from January 2015 to July 2016 during 12months followup. Structured questionnaire with demography, past and current history, past andcurrent treatment, weight and physical examination, past and current EEG, head CT scan, Biologywas collected for all patients. Weight and attacks were reported monthly by parents in an agenda.And systematic visit with a neurologist and EEG were performed every six months. , Absence ofattacks by neurologist and normal EEG control were the gold standard to define effective treatment.Weight gain was defined as an increase of at least 3000g of weight for age < 6months, 2000g for <12months, 1000g for <24 months and 500g for others on successive visits. A correlation betweenweight gain and treatment effectiveness was measured using ROC curve methods. Results: Weincluded 106 children with 64 boys and 42 girls, mean age are 23,04 mounts from 1 days to 59months Yearold. Treatment were effective at 6 months and 12 months for respectively 91,5% and79,24% patients. Weight gain was present in 81,44% of children with effective treatment comparedwith 11,11% for children with ineffective treatment. Weight gain was present in children with effectivetreatment at 6 months and at 12 months for respectively, 88,65% and 89,28% patient. Thus at 6months, the sensitivity and specificity of weight gain to detect effective treatment were respectively88.65%, and 77.78%, with a positive and negative predictive values of respectively 97.77% and38.38%. At 12 months, its sensitivity and specificity were respectively of 89.28% and 54.54%, withpositive and negative predictive values of respectiveley of 88.23% and 57.14%. Comments: Ourresults suggest that weight gain could be a good candidate to assess effective treatment amongepileptic children under 5 years old. We are seeking for collaboartion to develop this approach.


ID : 200143


TITLE : LONGTERM ENDURANCE AND OUTCOMES OF CAROTID STENTING AND CAROTIDENDARTERECTOMY

Author : Rustambek Karimov [1] , Okhunova Shakhnoza [2]

Affiliation : [1]Tashkent Medical Academy, [2]Tashkent


ABSTRACT : Objective. To estimate the longterm endurance and outcomes of carotid angioplastyand stenting (CAS) compared with carotid endarterectomy (CEA). Methods. We searched forrandomized controlled trials comparing CAS with CEA for carotid stenosis. Studies were classifiedaccording to symptom status: symptomatic, asymptomatic, or all inclusive stenosis. Postproceduralipsilateral stroke, restenosis/occlusion after revascularization, procedural stroke/death/myocardialinfarction (MI), and postprocedural ipsilateral stroke were evaluated. Subgroup analysis wasconducted in accordance with followup duration. Results. 22 studies were included and classified formetaanalyses in relation to specific outcomes. The maximum followup duration was 10 years. Therisk of postprocedural ipsilateral stroke in CEA was equivalent to that in CAS, irrespective of symptomstatus or followup time points. The CAS group had a greater risk of restenosis/occlusion afterrevascularization compared with CEA in studies of all inclusive stenosis. A similar tendency was foundin studies of symptomatic stenosis, but without statistical significance. However, subgroup analysisshowed that the risk of restenosis/occlusion in CAS decreased gradually with time, to the extent thatthese risks became comparable 1 year after the procedure. Procedural stroke/death/MI andpostprocedural ipsilateral stroke occurred more frequently in the CAS group in studies of symptomaticstenosis although not in studies of asymptomatic or all inclusive stenosis. However, this associationdid not persist when studies were divided according to followup time points. Conclusions. AlthoughCAS may be more strongly associated with periprocedural stroke/death compared with CEA, it couldbe a good alternative to CEA in terms of longterm durability and outcomes.


ID : 200144


TITLE : EPIDEMIOLOGIE ET PROFIL EVOLUTIF DES ACCIDENTS VASCULAIRES DU TRONCCEREBRAL AU CHU CAMPUS DE LOME

Author : J.E. DIATEWA [1] , JJ DONGMO [1] , TALABEWUI A. [1] , A. Balogou [1]

Affiliation : [1]Service de neurologie, Centre Hospitalier et Universitaire Campus de Lomé, TOGO


ABSTRACT : Introduction –Les accidents vasculaires (AVC) du tronc cérébral présentent unecertaine particularité qui rend compte de leur gravité et des difficultés de leur prise en charge.Objectifs Décrire les aspects épidémiologiques, cliniques et évolutifs des AVC du tronc cérébral chezles patients suivis au CHU Campus de Lomé Méthodes – Une étude transversale et descriptive a étéréalisée du 1er janvier 2014 au 31 décembre 2016. Elle a concerné les patients suivis pour un AVClocalisé au tronc cérébral et confirmé par l’imagerie cérébrale. Le tableau clinique initial, l’imageriecérébrale à l’admission, les facteurs étiologiques et l’évolution ont été évalués. L’étude statistique aété faite grâce au logiciel SPSS version 21 et le test de Chi2. Résultats – Sur 1789 cas d’AVC, 50étaient localisés au tronc cérébral ; soit une prévalence globale moyenne de 5.6%. Les ischémiesreprésentaient 64% dont 78.1% de ramollissement. L’âge moyen était de 57,6 ans. Le sexratio F/Hétait de 1,08. La localisation pontique était en moyenne de 38%, tout type d’AVC confus pour unscore de Glasgow liège initial de 16,74 en moyenne. L’HTA était à la fois le facteur de risque etétiologique principal surtout en cas d’hémorragie, respectivement dans 64% et 82,4% des cas. Lamortalité globale était de 30%, dont 18% en hospitalisation. Conclusions – La fréquence et lamortalité élevées des AVC du tronc cérébral comparativement aux autres localisations rendentcompte de leur prise en charge difficile nécessitant une implication multidisciplinaire.


ID : 200146


TITLE : PROFILS éLECTRONEUROMYOGRAPHIQUES DU SYNDROME DE GUILLAIN BARRé(SGB) AU COURS DE L’éPIDéMIE AU VIRUS ZIKA (ZIKV) EN MARTINIQUE

Author : APETSE Kossivi [1] , EDIMO NANA Mireille [2] , SIGNATE Aissatou [2] , TABELLAH Irène[2] , GRIMAUD Jérôme [2] , NAZAROV Boris [3] , [4]

Affiliation : [1]Service de Neurologie, CHU Campus, Lomé, Togo ET Service des ExplorationsFonctionnelles du Système Nerveux, CHU Martinique, Fort de France, France , [2]Service deNeurologie, CHU Martinique, Fort de France, France, [3]Service des Explorations fonctionnelles duSystème Nerveux, CHU Martinique, Fort de France, France, [4]


ABSTRACT : Introduction : La première infection humaine à ZIKV a été rapportée au Nigeria en1954. En Martinique, environ 30 cas de SGB ont été enregistrés lors de l’épidémie à ZIKV 20152016alors que l’incidence annuelle auparavant était de huit cas. Objectif : Rapporter les données desexamens électroneuromyographiques consécutifs (1er ENMG avant S4 et un second après S6 dessymptômes neurologiques) du SGB au cours de l’épidémie. Méthode : Les patients ont bénéficiéd’une recherche d’infection récente à ZIKV et au moins un ENMG. Sur le 1er ENMG, le sural sparedpattern (SSP) a été recherché et les critères conventionnels ont été utilisés pour classer endémyélinisant, axonal ou inexcitable. Sur le second ENMG, les patterns de déremyélinisation et «réversible conduction failure » (RCF, régression des troubles de conduction nerveuse sansdispersion) ont été recherchés. Résultats : 23 patients dont 19 (82%) avec preuve biologique d’uneinfection récente à ZIKV ont été inclus (âge moyen=61 ans ; sex ratio=0.52). Sur les 18 ENMG avantS4, 17 patients (94%) avaient un SSP, 16 (89%) étaient classés « démyélinisant ». Sur les 20 ENMGaprès S6, 18 (90%) patients avaient des signes de déremyélinisation. Discussion : Contrairementaux premiers cas d’association infection ZIKVSGB rapportés en Polynésie Française, c’est le soustype démyélinisant de SGB qui prédomine en Martinique. Les mécanismes d’atteinte neuropathiquedu virus restent inconnus. Conclusion : Au cours de l’épidémie à ZIKV en Martinique, l’incidence duSGB a augmenté et le pattern ENMG démyélinisant est le plus rencontré.


ID : 200147


TITLE : ENCEPHALOPATHIE EPILEPTIQUE INFANTILE PRECOCE A LOME

Author : Josué E. DIATEWA [1] , Komi AGBOTSOU [1] , V. CODJIA [1] , AA Koffi BALOGOU [1]


TOPIC : Epilepsy

ABSTRACT : Introduction L’encéphalopathie Epileptique Infantile Précoce (EIEP) ou syndromed’Ohtahara est l’une des encéphalopathies néonatales avec tracé de « suppressionburst ». Elle estrare, et présente des caractéristiques électrocliniques, thérapeutiques et évolutives particulièresObservation Nous rapportons le cas d’une fillette, sans antécédent particulier, suivie au CHUcampus de Lomé pour des spasmes toniques prédominant à l’hémicorps gauche, évoluant depuis le12e jour de vie. Elle faisait 3 à 6 crises par jour. Ces crises étaient rebelles au traitement. A l’âge de 2mois, on notait un retard du développement psychomoteur. L’EEG de sommeil montrait un pattern deSB avec des bouffées d’ondes lentes, amples, mêlées de pointes, pointesondes. L’imageriemédicale et le bilan métabolique étaient normaux. Aucune étiologie n’avait été retenue. L’évolutionélectroclinique à l’âge de 5 mois était marquée par des épisodes d’états de mal convulsifs etl’aggravation du retard de développement psychomoteur. L’EEG de sommeil était superposable auprécédent avec des graphoéléments prédominant à l’hémisphère droit, tandis qu’à l’éveil il setransformait partiellement en hypsarythmie (vidéos). Après 3 semaines sous carbamazépine 20mg/kg par jour, et phénobarbital 5mg/kg par jour, la fréquence des crises avait été réduite.Conclusion Les ENP avec SB sont sous diagnostiqués. La stigmatisation liée à l’épilepsie et le décèsprécoce pourraient l’expliquer. La sensibilisation et la recherche scientifique restent de rigueur.


ID : 200148


TITLE : LA NEUROMYELITE OPTIQUE A LOME

Author : Josué E. DIATEWA [1] , Kossivi APETSE [1] , Michel TASSA [1] , K. ASSOGBA [1] , AAKoffi BALOGOU [1]



ABSTRACT : Introduction La neuromyélite optique (NMO) est une pathologie inflammatoiredémyélinisante rare. Les nouveaux critères diagnostiques du spectre des NMO ont permis de sortirde l’ombre cette affection, particulièrement en Afrique où quelques cas ont été rapportés.Observation Nous présentons le cas d’une patiente de 26 ans hospitalisée dans le service deneurologie du CHU Campus de Lomé pour récurrence après un an, d’une tétraparésie d’apparitionrapidement progressive en 4 semaines, associée à une allodynie tactile de C2 à T1 à une EVA de8/10, une dyspnée, un flou visuel et un sub ictère. Les mêmes symptômes neurologiques étaientretrouvés chez le père décédé il y a 10 ans. Le fond d’œil retrouvait une névrite optique bilatérale.L’IRM médullaire mettait en évidence une myélite étendue de C2 à C7. Le dosage des anticorps antiAQP4 était positif. Le bilan hépatique notait une insuffisance hépatocellulaire sans atteinte virale.L’évolution était marquée par des poussées de dyspnées et le décès survenu après deux mois souscorticothérapie à forte dose. Le contrôle radiologique n’a pu être fait. Conclusion La NMO encoresous diagnostiquée et imparfaitement explorée, demeure une affection grave souvent en rapportavec la localisation anatomique. Elle nécessite une prise en charge adéquate. Des étudesmulticentriques et surtout génétiques méritent d’être réalisées. Mots clés Neuromyélite optique,Anticorps antiAQP4, Afrique, Zone tropicale


ID : 200149


TITLE : CLINICAL AND MAGNETIC RESONANCE IMAGING FEATURES OF MULTIPLE SCLEROSISIN THE NORTH AFRICAN MEDITERRANEAN REGION

Author : Mohammad Aboulwafa [1]

Affiliation : [1]Neurology Department AlAzhar University Cairo Egypt


ABSTRACT : Introduction Multiple sclerosis (MS) shows variable disease characteristics at differentethnicities and geographical regions. Magnetic resonance imaging (MRI) features of MS are notadequately described in African mediterranean region. We aimed to describe main clinical and MRIfeatures of MS in Egyptian patients. Methods Relapsing onset MS patients (n=28) and a group ofmatched healthy controls (n=18) were recruited. All subjects had a standardized clinical evaluation,and an MRI examination (1.5 Tesla scanner, FLAIR and T2 for lesion load (LL) estimation and asagittal 3DT1 for volumetric assessment). Analysis included LL estimation (MIPAV software), wholebrain atrophy (SIENAX method), subcortical segmentation (FIRST part of FSL software) and meanupper cord crosssectional area CSA. Correlation between clinical and MRI parameters were doneusing partial correlation. Results Demographic, clinical and MRI disease related characteristics areprovided in Table 1. Significantly lower values were observed in patients group for normalized brainvolume (NBV) (p<0.03), thalamic fraction (P<0.003), hippocampi (P<0.002 and P<0.01 right and left),but unexpectedly not for cord crosssectional area CSA (P<0.1). EDSS correlated with with LL(p<0.01 r=0.58), NBV (p<0.03, r=0.52), normalized cortical fraction (p<0.003, r=0.68), thalamicfraction (p<0.04, r=0.49), but not the cord CSA (p<0.3). Conclusion. Clinical and MRI parameters ofMS appear similar to European data, despite differences in geography and ethnicity. Main differencesare lesser total intracranial volume and cord CSA values and absence of correlation between cordCSA and disability which warrants further investigation.


ID : 200155


TITLE : BRACHIAL PLEXOPATHIES IN ADULTS: A RARE ENTITY

Author : Moalla Khadija Sonda [1] , Farhat Nouha [1] , Hdiji Olfa [1] , Haj Kacem Hanen [1] , KallelRaida [1] , Damak Mariem [1] , Mhiri Chokri [1]

Affiliation : [1]Habib Bourguiba Hospital Sfax Tunisia


ABSTRACT : Background: Brachial plexopathy (BP) causes weakness, sensory loss, and loss oftendon reflexes in body regions innervated by nerves in the C5T1 segmental distribution. The clinicaldiagnosis is confirmed by electrodiagnostic studies (EMG). We attempted to estimate clinical andelectrodiagnostic features of BP. Methods: We retrospectively identified cases of BP among patientsseen from 2009 at the department of neurology at Habib Bourguiba hospital (Sfax, Tunisia). Allpatients were examined and underwent an EMG study. Results: Three patients (2 males, 1 female),with a mean age of 53 years, were identified. All patients had pain in the upper limb followed byparesthesia and weakness. The mean duration of symptoms was five months. Clinical examinationshowed motor deficit as well as sensory impairment and areflexia in all patients. One patient hadbilateral involvement. EMG showed no systematized BP in all cases. MRI of the brachial plexus wasperformed in one patient, with no past history, excluding lesions due to primary or secondary tumorsor trauma. ParsonageTurner Syndrome was considered in two cases. The remained case had postoperative BP after median sternotomy. All patients was treated symptomatically. One patient wastreated by oral steroids with partial improvement. Conclusion: Evaluation of the BP presents a greatchallenge to the clinician. It should be considered for any pain or weakness that tended topredominate in muscles innervated by specific trunk and they must be differentiated fromradiculopathy or neuropathy with conduction block. EMG studies confirm the diagnosis and MRIfeatures can help to distinguish particular entities.


ID : 200156


TITLE : MIGRAINE: A RISK FACTOR FOR DISSECTION OF CERVICAL ARTERIES

Author : Moalla Khadija Sonda [1] , Hdiji Olfa [1] , Haj Kacem Hanen [1] , Farhat Nouha [1] , Damak Mariem [1] , Mhiri Chokri [1]

Affiliation : [1]Habib Bourguiba Hospital Sfax /Tunisia


ABSTRACT : Introduction: Cervical artery dissection (CAD) is the most common etiology for stroke inyoung adults. Migraine is a known risk factor for ischemic stroke. The association between CAD andmigraine was suggested but the mechanisms are not yet clear. Case report: We report the case of awoman aged of 35 yearold, with a personal history of migraine, who was admitted with a brutal lefthemiparesis preceded by recrudescence of intense migraine headache without aura 2 days ago.Neurological examination found left brachiofacial hemiparesis. Brain MRI showed a right superficialmiddle cerebral artery stroke. MRA disclosed extra cranial right carotid dissection treated by oralanticoagulants. Discussion and conclusion: Prevalence of migraine in patients with CAD is quite high(36%). Patients suffering from migraine that present CAD tend to have multiplevessel dissectionsand more intensive migraine attacks (especially with aura) than others. There is evidence indicatingthat both migraine and CAD are multifactorial diseases with genetic predisposition. The comorbidity ofCAD and migraine could also be mediated by impaired systemic endotheliumdependent vasodilationthat has been demonstrated in CAD patients, possibly exposing arterial walls to damage andsubsequent dissection. It was suggested that the repeated vomiting due to migraine causesstretching of patient’s neck and could predispose to CAD by mechanical damage to the cervicalarteries. Migraine activity appears to be alleviated by CAD. The effect of CAD and ischemic stroketreatments, such as the use of anticoagulants and antihypertensive medications, remains unclear.


ID : 200158


TITLE : SYNDROME DE WEST : ASPECTS CLINIQUES, éTIOLOGIQUES, THéRAPEUTIQUES ETéVOLUTIFS CHEZ DES ENFANTS SUIVIS à DAKAR

Author : Fidelie Scholastique NGOUNGOURE HALIMA [1] , Adjaratou Sow [1] , MouhamadouMansour NDIAYE [1] , Jean Marie TolaBabatoundé DOGNON [2] , Moustapha NDIAYE [3]

Affiliation : [1]Neurosciences Department Fann National Teaching HospitalFaculty of MedicineCheikh Anta Diop University,Dakar Senegal, [2]Université El Hadji Ibrahima Niasse, School ofMedicine Saint Christopher Iba Mar Diop, Dakar, Senegal, [3]Neurosciences Department FannNational Teaching HospitalFaculty of MedicineCheikh Anta Diop University Dakar Senegal

TOPIC : Epilepsy

ABSTRACT : • Introduction Le syndrome de West (SW) est l’encéphalopathie épileptique la plusfréquente du nourrisson. • Objectif L’objectif de cette étude était de décrire les aspects cliniques,étiologiques, thérapeutiques et évolutifs du SW chez des enfants suivis à Dakar (Sénégal). • MéthodeUne étude rétrospective et descriptive a été menée à la Clinique de Neurologie du Centre HospitalierNational Universitaire de Fann et à l’Hôpital National d’Enfants Albert Royer. Les dossiers médicauxcomplets de tous les enfants atteints du SW entre Avril 2004 et Mars 2015 ont été analysés. Lesdonnées suivantes étaient recueillies : cliniques, électroencéphalographiques, neuroimageriques,biologiques, étiologiques, thérapeutiques et évolutives (24 mois). • Résultats Les dossiers de 93enfants ont été analysés. L’âge moyen était respectivement de 10 mois (extrêmes 236) audiagnostic et de 6 mois au début des spasmes. Une prédominance masculine était notée (81,7%).Les spasmes en flexion étaient les plus fréquents (92,5%). Un retard psychomoteur était retrouvéchez 88% d’enfants. L’EEG intercritique montrait une hypsarythmie typique (34%) et atypique (66%).La principale étiologie retrouvée était l’encéphalopathie anoxoischémique périnatale (40,7%). Lemédicament le plus prescrit était le valproate (63,8%) suivi de l’association antiépileptiquesbétaméthasone. Chez 2/3 d’enfants, une cessation des spasmes était obtenue et le développementpsychomoteur était stationnaire. • Discussion La prédominance des causes périnatales est retrouvéedans la littérature. Le choix de la bétaméthasone et du valproate est le fait de leur accessibilitéfinancière. • Conclusion Le SW reste un défi thérapeutique au Sénégal.Le renforcement de la luttecontre les facteurs de risque périnataux et l’accessibilité aux médicaments spécifiques pourraientaméliorer sa prise en charge.


ID : 200160


TITLE : NOCICEPTIVE BLINK REFLEX IN PATIENTS WITH MYOFASCIAL TEMPROMANDIBULARDISORDER (MTMD) AND HEALTHY CONTROLS

Author : Ishraga A. Elhag [1] , Afraa M.M. Musa [2] , Ahmed M. Suleiman [3] , Ammar E.M. Ahmed[4]

Affiliation : [1]Lecturer / Physiology Department/ Faculty of Dentistry/University of Khartoum, [2]Assistant professor/Physiology Department/ Faculty of Medicine/ University of Khartoum , [3]Professor of Maxillofacial Surgery/Department of Oral Surgery/Faculty of Dentistry / University ofKhartoum/Sudan, [4]Professor/ Senior consultant neurologist/ Clinical neurophysiologist/ Faculty ofMedicine / University of Khartoum /Sudan


ABSTRACT : BACKGROUND: MTMD is a common chronic orofacial pain disorder affectingtempromandibular region. The underlying nociceptive mechanisms in muscles and joints are stillunsettled. AIM of this study was to assess the parameters of R2 component of nociceptivespecificblink reflex (nBR) in order to investigate the trigeminal nociceptive system and compare MTMDpatients and healthy controls. METHODS In 33 MTMD patients and 33 controls that were strictlymatched for age and sex, mental nerve blink reflex was recorded using nociceptive specificstimulating electrode and recorded from both orbicularis oculi muscles with disposableelectromyography recording electrodes. Stimulating current (mA) was predetermined; I0 and IP for allparticipants. Response area (mV/ms) and onset latency (ms) of the ipsi and contralateral R2component of the blink reflex were calculated. Data was stored for offline analysis using PCbasedprogram. One way analyses of variance and unpaired students T test were used for statisticalanalysis, significance level was set (P value= 0.05). RESULTS: Is and Ip for patients were significantlylower than that of controls (P values ≤ 0.05), R2 onset latencies were significantly prolonged inpatients compared with controls (P values = 0.000), the response area (mV/ms) for R2 was lower inpatients compared with controls (P values ≤ 0.05). CONCLUSION: These findings showeddisturbances in the central processing of nociceptive pathways and might be helpful to improveknowledge for diagnosis and treatment evaluation of MTMD and to raise awareness aboutusefulness of brainstem reflexes in exploring the trigeminal pathways in other craniofascial paindisorders.


ID : 200164


TITLE : PREVALENCE OF NERVE CONDUCTION ABNORMALITIES IN TYPE 1 DIABETESMELLITUS

Author : Hana Ahmed [1] , Nimat Abuelwafaa1 [1] , Ilham Omer [2] , Mohamed Abdullah [3] , Ammar E.M. Ahmed [4] , Afraa Musa [5]

Affiliation : [1]Teaching assistant/ Physiology department/ faculty of Medicine / University ofKhartoum / Sudan, [2]Associate professor/ Department of Paediatrics/ Faculty of Medicine /University of Khartoum/Sudan, [3]Professor/ Department of Paediatrics/ Faculty of Medicine /University of Khartoum/Sudan, [4]Professor/ Senior consultant neurologist/ Clinical neurophysiologist/Faculty of Medicine / University of Khartoum /Sudan, [5]Assistant professor/ Department ofphysiology Faculty of Medicine / University of Khartoum/Sudan


ABSTRACT : Background &Objectives: Diabetic peripheral neuropathy (DPN) is the commonestmicrovascular complication in diabetic patients. Unlike type2 DM, children with type1 DM rarelydevelop the classical features of neuropathy. Nerve conduction study (NCS)is an objective, noninvasive electrophysiological test for diagnosing DPN. The aim of this study is to detect and estimatesubclinical cases in type1 diabetic children based on NCSparameters(Latency,Amplitude&Conduction Velocity). Design/Methods: Bilateral NCSs of the sensory & motorlower limb nerves were performed. This study recruited 50 type 1diabetic children with differentdisease duration(4.92±3.84 years)attending Sudan Childhood Diabetes Center, their meanage(15.00±2.19 years),42%were males&58%were females. In addition 25healthy children werestudied as controls to patients, their mean age was (13.88±2.46 years), 38.46% were males while61.54% were females. Results: Out of 50diabetic patients, 88%were found to haveelectrophysiological features of peripheral neuropathy, out of which 76%had NCS evidence ofneuropathy without clinical manifestations while 12%had clinical evidence of neuropathy. The studyshowed extremely high significant difference between the sural,commonperoneal&posteriortibialNCS parameters of the patients group compared to the control group [Pvalues<0.005]. Diabetesmellitus significantly prolonged the latency, decrease the conduction velocity and amplitude of thesensory (SNAP)& motor(CMAP)action potentials of all the tested lower limb nerves. Conclusion: Ourstudy revealed high prevalence of subclinicalDPN. The effect of DM on all of the NCS parameterswas highly significant in the lower limbs nerves. Detection of subtle nerve dysfunction will aid inpreventing or delaying the progression into overt clinical neuropathy and encourage patients forprompt metabolic control of their disease.


ID : 200165


TITLE : PSORIASIFORM DRUG ERUPTION ASSOCIATED WITH SODIUM VALPROATE

Author : Ketata gargouri S, Abdelmaksoud zouari W [1]

Affiliation : [1]regional hospital of Mahres, Sfax, Tunisia

TOPIC : Other

ABSTRACT : INTRODUCTION Among the AEDs, sodium valproate is relatively free from skin allergy.This report describe a patient who developed sevee psoriasiform eruption with sodium valproate.CASE REPORT A 12yearold boy presented to us with complaints of generalized tonicoclonicseizures associated with an elevated temperature. The neurological exam was normal. He had ahistory of simple febrile seizures started at 2 years old and treated with sodium valproate for 4 years.Between 6yearold and 12yearold, he was seizure free. he was put on sodium valproate 200mgthree times per day. Approximately three months after starting sodium valproate, he presented with apsoriasiform eruption on his limbs, legs and trunk. He had not taken any other medication, and hehad no personal or family history of psoriasis. Routine laboratory investigations including completeblood cell count, liver and renal function tests were normals. On dermatologic examination he haderythematous white scaly, sharply bordered plaques and papules on back of his hands, upper limbs,knees and trunk.Themorphology of the lesions was suggestive of psoriasiform eruption. Patient wasdiscontinued of valproate and was started on phenobarbital. He had no treatment for hispsoriasoform eruption. The eruption completely disappeared after tow months. CONCLUSIONDevelopment of psoriasiform eruption with the initiation of valproate and subsequent remission of thelesions with the discontinuation of the drug and subsequent course clearly suggests a causal relationbetween valproate and skin lesions.


ID : 200166


TITLE : NEUROLOGICAL COMPLICATION OF LEAD POISONING

Author : Dr. Boulahia Imen [1]

Affiliation : [1]Dr. Boulefkhad Assia CHU Constantine Algeria

TOPIC : Other

ABSTRACT : Lead poisoning is an excessive impregnation of individuals, especially children, to lead.This substance is toxic to the body, even at low concentration. This poisoning is a cause of variousneurological complications which can be acute (lead encephalopathy) or chronic (damage to theperipheral nervous system). Comment: Patient 37 years Mansouri abdelhalim aged 37; married for 2years without children. Presentation to the lead since September 2015 (used in profession batteryfactory); in whom neurological examination has objective: Engine peripheral neurogenic syndrome ofboth upper limbs bilateral and asymmetric focal mononeuropathy affecting the bilateral radial nervetype and prevails on the right. Electromyography has objectified: pure driving peripheral neurogenicdamage to type axonal interesting territory of two radial nerves. Review samatique: Gingivitis ofBurton digestive disorders: colic, vomiting with an ultrasound abdominopelvienne aobjective: adiscrete homogeneous hepatomegaly and hypoechoic splenomegaly. Anemia hypochromicmicrocytic: NSF: Hb11 g/dl /HT at 40 /CCMH to 27 g/dl /Fer serum: 1 mg/ The diagnosis of leadpoisoning was asked and confirmed by biology Blood lead: 678, 6ug/l (inf to 85ug/l) dosing of aciddeltaaminolevulenique: 5 mg/l (inf 20 mg/l) Conclusion: Lead poisoning remains a public healthproblem that may still be underestimated; consequence to the nonspecificity of the symptoms thatcan be confused with a minor problem for most, and the blood lead level is rarely proposed.


ID : 200170


TITLE : RELATION BETWEEN COGNITIVE DYSFUNCTION AND CLINICAL PARAMETERS INEGYPTIAN MULTIPLE SCLEROSIS PATIENTS

Author : haidy mohamed elshebawy [1] , ebtisam fahmy [2] , nervana el fauomy [2] , [3]

Affiliation : [1]assistant lecturer of neurologyfaculty of medicine cairo university Egypt, [2]professorof neurologyfaculty of medicine cairo university Egypt, [3]Egypt


ABSTRACT : Rationale: Cognitive impairment is reported in up to 65 percent of Multiplesclerosis(MS) patients.This study aimed to assess cognitive functions and examine its relation toclinical parameters and disease disability in Egyptian MS patients. Methods: Fortyfive clinicallydefinite MS patients and twenty matched healthy controls were included in the study. Patients wereexamined clinically and disability was assessed using Expanded Disability StatusScale(EDSS).Cognitive assessment was done for all participants using Minimental stateexamination(MMSE), Addenbrooke’s Cognitive Examination III(ACEIII),paced auditory serial additiontask(PASAT),Controlled Oral Word Association Test(COWAT)words and animals and trail making test.Results: MS patients showed significant worse performance than controls in all cognitive scales(P ≤0.05).Relapsing remitting MS patients showed significant better performance than secondaryprogressive MS patients on all cognitive scales( P ≤ 0.05)except for ACE(visuospatial)and COWATanimals(P>0.05). Patients with cerebellar first attack showed the worst performance in ACE languageand attention(P =0.036, 0.013).Patients on immunomodulatory drugs showed significant betterperformance than those on immunosuppressive medications in all cognitive scales(P ≤ 0.05)exceptfor ACE (visuospatial),COWAT animals and trail making test(P>0.05).Patients with higher educationallevel showed significant better performance in(ACE language, PASAT and COWAT words)(P=0.014,0.046 and 0.001).A significant negative correlation was found between EDSS score,frequency ofattacks/year, duration of illness and MMSE and total score of ACE(P≤0.05). Conclusion: Cognitivedomains affected in MS patient include attention,working memory, verbal fluency, executive functionsand information processing speed. MS patients more prone to cognitive impairment are those withlow educational level, progressive disease, EDSS score ≥5, long duration, cerebellar first attack, andthose on immunosuppressive medications.


ID : 200171


TITLE : DEEP BRAIN STIMULATION IN PARKINSON’S DISEASE. A RETROSPECTIVE STUDY OF19 CASES.

Author : imane el alaoui el barhiti [1] , Mounia Rahmani [1] , Souad el hadri [1] , boutbibe fatima [1], senhaji siham [1] , mustapha elalaoui faris [1] , Benabdeljlil Maria [1] , sadia aidi [1] , Fouadbellakhdar [2] , rachid gana [2] , nizare el fatemi [2]

Affiliation : [1]Neuro A and neuropsychology, [2]neuroseurgery


ABSTRACT : Introduction: Deep brain stimulation (DBS) is currently the best treatment of advancedparkinson’s disease (PD) with motor complications. We present a retrospective study of PD patientswho underwent DBS of subthalamic nucleus (SBN) between May 2008 and January 2017. Materialsand Methods: Our study included 19 cases. Motor complications and or dyskinesias were present inall cases. Presurgical evaluation consisted in Dopa’s testing, brain MRI and neuropsychologicalexploration. Results: There were 8 women and 11 men with a mean age of onset 41 years. Meanduration of disease was 13.8 years. Clinical presentation was akinetic and rigid in 10 cases, mixed in7 cases and predominant tremor in 2 patients. All patients had motor fluctuations. Non motorfluctuations were present in 5 cases and dyskinesias in 13 cases. Before surgery, the meanLevodopa equivalent daily dose (LED) was 1187 mg and the improvement of motor section III ofUPDRS was 70%. In 25 SBN, the definitive electrode was the one which had the best physiologicalrecording. It was central in 15 cases, medial in 10 cases, anterior in 5 cases, posterior in 4 cases andlateral in 1 case. Six months after surgery, the mean improvement of LED was 63% and of theUPDRSIII was 73 %. Discussion and Conclusion: DBS reduces motor disability and improves qualityof life in patients with advanced PD with severe motor complications. Our results are similar withlitterature. We discuss clinical outcomes, electrophysiological, surgical issues and the new concept of“early stimulation”.


ID : 200174


TITLE : AICARDIGOUTIèRES SYNDROME IN MOROCCAN POPULATION.

Author : Adnane KARKAR [1] , Imen DORBOZ [2] , Sellama NADIFI [3] , Odile Boespflug Tanguy [4]

Affiliation : [1]Genetics and Molecular Pathology Laboratory, Faculty of Medicine and pharmacy ofCasablanca, Hassan II University ; Inserm U1141, Paris Diderot University, Sorbonne Paris Cité, DHUPROTECT, Robert Debré Hospital, Paris, France, [2]Inserm U1141, Paris Diderot University,Sorbonne Paris Cité, DHU PROTECT, Robert Debré Hospital, Paris, France, [3]Genetics andMolecular Pathology Laboratory, Faculty of Medicine and pharmacy of Casablanca, Hassan IIUniversity, [4]Inserm U1141, Paris Diderot University, Sorbonne Paris Cité, DHU PROTECT, RobertDebré Hospital, Paris, France ; Reference Center For Leukodystrophies, Department ofNeuropediatrics and Metabolic Diseases, Robert Debré Hospital, APHP, Paris, Fran


ABSTRACT : AicardiGoutières Syndrome (AGS) is a severe encephalopathy characterized in itsmost severe form by cerebral atrophy, leukodystrophy, calcification of the basal ganglia and whitematter, chronic cerebrospinal fluid (CSF) lymphocytosis, increased CSF interferon alpha (IFNA1), andnegative serologic investigations for common prenatal infections. AGS is sometimes mistaken for thesequelae of congenital infection, due to an important mimic of acquired in utero viral infection. Severeneurologic dysfunction becomes clinically apparent in infancy, and manifests as progressivemicrocephaly, spasticity, dystonic posturing, profound psychomotor retardation, and often death inearly childhood. Outwards the nervous system, thrombocytopenia, hepatosplenomegaly, andelevated hepatic transaminases along with intermittent fever may also erroneously suggest aninfective process. In 2006 Crow et al. identified a homozygous 529 GA transition in exon 7 ofRNASEH2B, resulting in an Ala177toThr substitution (c.529G>A (p.Ala177Thr)). The familiesincluded in the latter study were of distinct nationalities including Moroccan and North African. In total,20 of the 36 mutant alleles in 18 AGS families were A177T. In 2014 Crow et al. also identified thissame mutation in 3 North African patients with a phenotype of nonsyndromic spastic paraplegia andnormal neuroimaging, this results emphasized the phenotypic variability associated with AGS.Knowing that the A177T mutation is mainly described in the North African population, we sought toassess it by sequencing 104 healthy Moroccan individuals and calculating its prevalence. We alsosequenced Moroccan patients with an AGS phenotype who did not have a molecular diagnosis yet.


ID : 200177


TITLE : MALADIE CEOLIAQUE COMPLIQUéE D’ENCéPHALOPATHIE DE GAYET WERNIKé

Author : F Belabbes [1]

Affiliation : [1]F Haddad,M Tahiri,A Bellabah,W Hliwa,W Badre


ABSTRACT : La neuropathie périphérique nutritionnelle avec atteinte du SNC désigne unepolyneuropathie provoquée par une carence en vitamines, et plus spécifiquement celles du groupe Bpouvant être de causes variés ou associées a une maladie cœliaque. L’encéphalopathie non traité,peut dégénérer et entrainer un coma devenant une urgence médicale. But de travail : Rapporter unecomplication rare de la maladie cœliaque chez l’adulte à travers une observation : Encéphalopathiede Wernicke. Observation : Il s’agit d’une patiente âgée de 46 ans, sans ATCD pathologiques, quiprésentait depuis 6 mois des vomissements alimentaires sans trouble de transit, la patiente rapportaitdes céphalées et photophobie. L’examen clinique a retrouvé une patiente asthénique, avecamyotrophie distale des 4 membres. Au bilan biologique, nous avons retrouvé un syndrome demalabsorption, la FOGD a été faite objectivant une gastrite antrofundique avec à l’étudeanatomopathologique une atrophie villositaire grade 3 et. Le tableau s’est compliquée parl’installation des trouble de conscience, syndrome confusionnel, d’un strabisme et nystagmusbilatéral, un bilan a été fait(BHE, PL, TDM cérébrale, cortisolémie de 8H )s’est révélé normal, Letableau nous faisant évoquer un tableau d’hypovitaminose B avec atteinte neurologique typeencéphalopathie de Werniké, un traitement d’épreuve à base de vitaminothérapie B injectable a étédémarré avec amélioration immédiate de la patiente. Conclusion : Les vomissements lors de lamaladie cœliaque chez un adulte est un signe de révélation fréquent pouvant être à l’origine decomplications neurologiques graves. Une supplémentation vitaminique précoce doit être instauréedans les formes ainsi qu’un régime sans gluten.


ID : 200181


TITLE : VESICOSPHINCTERIC DISORDERS IN MULTIPLES SCLEROSIS: A DESCRIPTIVE STUDY

Author : HAMZA NOUHA [1] , HDIJI OLFA [1] , HAJ KACEM HANEN [1] , BOUZIDI NOUHA [1] , DAMAK MARIAM [1] , MHIRI CHOKRI [1] , BEN NCIR SIHEM [2]

Affiliation : [1]DEPARTMENT OF NEUROLOGY IN THE HOSPITAL OF HABIB BOURGUIBA SFAXTUNISIA , [2]REGIONAL HOSPITAL OF GABES


ABSTRACT : Introduction: Vesicosphincteric disorders (VSD) are frequent in multiple sclerosis(MS)and lead to the diagnosis of this disease in 2 to 5% of cases. These disorders had been long timeunderestimated but now considered as a serious cause of handicap in multiple sclerosis patients.Objective: To describe vesicosphincteric dysfunction in 186 patients with MS. Methods: We reviewedthe clinical records of 168 patients with MS who were hospitalized in the neurology department in thehospital of “Hbib Bourguiba”in Sfax during the period from 1992 to 2010 and analysed their voidingsymptoms. Results: Our study was done on 186 patients with MS. There were 66 men and 120women (SR=0.55). The mean age was 41 ± 12 years (20 a 73 years). 69 patients have developedVSD (37.1 %) during the course of the disease and this trouble was inaugural in the rest of patients.62.9% had light handicap (sphincter score=0). The handicap was less severe in remittent recurrentform of MS (RR) comparatively to secondary progressive (SP) and primary progressive (PP) forms(score=0 in 77.8% of RRMS,38.3% of SPMS and 54.4% of PPMS). Discussion: The clinical signs aredominated by urgency (60 to 80%), frequency (40 to 60%) and incontinence. Dysuria occurs in 15 to30%. These disorders expose to urinary tract infection risk and upper tract damage for long term.Sexual dysfunction can be associated in many cases. Conclusion: VSD in multiple sclerosis arefrequent. Urodynamic studies are useful to prescribe adapted and early treatment.


ID : 200182


TITLE : PSYCHOGENIC MOVEMENT DISORDERS: REPORT OF 3 CASES

Author : HAMZA NOUHA [1] , HDIJI OLFA [1] , HAJ KACEM HANEN [1] , BOUZIDI NOUHA [1] , DAMAK MARIAM [1] , MHIRI CHOKRI [1]

Affiliation : [1]DEPARTMENT OF NEUROLOGY IN THE HOSPITAL OF HABIB BOURGUIBA SFAXTUNISIA


ABSTRACT : Background: Psychogenic Movement Disorders (PMDs) are a subtype of conversiondisorder. However, it is not easy to diagnose PMDs, especially in patients with underlying organi¬callycaused abnormal movements. Objective: We describe different clinical aspect of PMDs in threepatients. Results: We report the cases of 3 patients who presented with abnormal movements. Therewere 2 men and one woman whom age was greater than 50 years. These movements involvedupper limb and predominated in distal in one patient, neck and upper limbs in the second and thehemi body in the third. The findings of their routine laboratory tests were within normal limits andcerebral imageries were normal in 3 cases. Other psychogenic manifestations or triggeringpsychiatric factors were found in all patients. Discussion: Typical clinical characteristics of these PMDsare acute onset, fast progression, movement patterns incongruent with organic movement disorders,distractibility, variability and simultaneous occurrence of various abnormal movements anddysfunctions. Conclusion: The cause of PMDs is unknown and the underlying brain mechanismsremain uncertain. In the future, a better understanding of etiological mechanisms will allow to thedevelopment of more specific treatments.


ID : 200185


TITLE : AN EXPERIENCE FROM SUDAN WITH TUBERCULOSIS OF CENTRAL NERVOUS SYSTEM: AN EXTENSIVE STUDY OF CLINICAL AND RADIOLOGICAL FEATURES, TREATMENTOUTCOMES AND PREDICTORS OF MORTALITY IN 60 PATIENTS

Author : Mohamed Nagib Idirs [1] , Mohamed Alfaki [2] , Maha Elzubair [2] , Samira Mirgani [2] , Etedal Ibrahim [2] , Hiba Abugabl [2] , Taha AHakam [3]

Affiliation : [1]Faculty of Medicine, University of Khartoum, [2]National Neuroscience Centre,KhartoumSudan, [3]UCL Institute of Neurology, Queen Square, London


ABSTRACT : Introduction Tuberculosis is endemic in Sudan. Tuberculosis of central nervous system(CNS) is a serious form of the disease with high levels of morbidity and mortality. Objectives To studythe clinical and radiological features of tuberculosis of CNS, treatment outcomes and mortalitypredicting factors. Methods Prospective descriptive study of 60 patients with CNS tuberculosis.Results The mean age was 37.17±1.83 years. Females represented 51.7% of the cohort. Duration ofsymptoms was 7.78±0.8 weeks. Symptoms reported were headache (86.7%), fever (66.7%), weightloss (61.7%), nightsweats (56.7%), and seizures (53.3%). Clinical features on examination were longtract features (46.7%), cranial nerve involvement (45%), papilloedema (43.3%), meningeal irritation(31.7%), and decreased level of consciousness (33.3%). Final diagnosis was cerebral tuberculoma in65% (39/60), tuberculous meningitis (TBM) in 10% (6/60), and the remaining 25% were havingcombination of both. Brain tuberculomata were multiple in 51.7% of patients (31/60), while beingsingle in 38.3% (23/60). Brain oedema was observed in 78.3% (47/60); mass effect with midline shiftwas noted in 43.3% (26/60). Mean duration of treatment was 17.21 months. Complete recovery wasreported in 68.4% of patients (41/60), while 13.3% (8/60) had died. In patients with singletuberculoma, recovery was complete in 82.1%, whereas in TBM recovery was partial in 83.3%. Deathwas significantly related to type of diagnosis (P=0.000), number of tuberculomata (P=0.000) and theirsite (P=0.000), serum sodium (P=0.000), cerebral oedema (P=0.002), and level of consciousness(P=0.05), but not with duration of symptoms (P=0.259). Conclusion Cerebral tuberculomata was moreprevalent and had a more favourable outcomes when compared to TBM.


ID : 200191


TITLE : PREVALENCE AND CHARACTERISTICS OF DRUG RESISTANT EPILEPSY IN ADULTSUDANESE EPILEPSY PATIENTS

Author : Taha AHakam [1] , Hassab Elrasoul Siddig Ali [2] , Mohamed Alfaki [3]

Affiliation : [1]UCL Institute of Neurology, Queen Square, London , [2]Neilain Medical Centre,KhartoumSudan, [3]National Neuroscience Centre, KhartoumSudan

TOPIC : Epilepsy

ABSTRACT : Introduction One third of epilepsy patients continue to have seizures despite drugtherapy. Objectives To determine the prevalence and independent risk factors of drugresistantepilepsy (DRE) among adult Sudanese patients. Methods This is a retrospective crosssectionallongitudinal descriptive study. A total of 360 adult Sudanese epilepsy patients who attended a tertiaryneurology clinic in Khartoum city, Sudan between 2006 and 2010 were included. The study hasadopted the 2010 consensus definition of DRE launched by the International League AgainstEpilepsy. Results 23.9% (86/360) of all patients were classified to have DRE. In those with seizureonsetage < 13 years, prevalence was found to be 43% while being 8.3% in those with seizure onsetage > 65 years. In patients with a disease duration of > 10 years, 41% were found to have DRE, whilein those with a duration of 110 years prevalence was found to be 17 %. In patients with focal onsetseizures, prevalence was found to be 33% (62/188); while in those with generalized seizures wasreported to be 14% (24/172). Independent risk factors of DRE identified based on multivariate logisticregression analysis were: Learning disability (Odds ratio (OR) 9.404, 95% Confidence interval (CI)3.641 – 24.291), seizure type (OR 0.229, 95% CI 0.094 – 0.558), previous antiepilepsy drug therapyuse (OR 2.828, 95% CI 1.394 – 5.740), seizure onsetage (OR 1.616, 95% CI 1.112 – 2.348), andgender (OR 1.942, 95% CI 1.051 – 3.588). Conclusion The prevalence of DRE reported by this studynecessitate an action that can meet its burden.


ID : 200192


TITLE : HYPOKALEMIC PERIODIC PARALYSIS: CASE REPORT

Author : KALLEL.R [1] , ABIDA.I [2] , HAMMAMI.M [3]

Affiliation : [1]Neurology Unit, Regional Hospital of Kerkennah Islands, Sfax, Tunisia, [2]PsychiatryUnit, Regional Hospital of Kerkennah Islands, Sfax, Tunisia, [3]Réanimation Unit, Regional Hospitalof Kerkennah Islands, Sfax, Tunisia


ABSTRACT : Introduction Familial hypokalemic periodic paralysis (FHPP) is a rare congenitaldisorder. It causes intermittent and reversible episodes of muscle weakness associated withhypokaliemia. In children, hypokalemic paralysis secondary to gastroenteritis and chronic renaldisease is much more common than primary disease. Case report A 21yearold male, withoutfamilial history, presented with complaints of recurrent attacks of quadriparesia since the age of 17years. The patient used to have 34 such episodes every year. Each episode occurred suddenlywithout any particular precipitating factor. He was presented with an acute flaccid tetraplegia to thepoint of difficulty in sitting and walking without other neurological abnormalities. Spontaneousrecovery occurred over 636 hours every time. He has not taking medication or toxic. He wasconsidered as hysterical and addressed to the psychiatrist. During the last paralytic episode, wefound low serum potassium levels (2.5 mEq/L) and all other related investigations (blood and urinary)were normal. General examination was normal. Spontaneous totally recovery occurred over 16 hourswith normal value of serum potassium (4mEq/l) and normal EKG presentation. Electroneuromyogramdone after recovery were normal. Considering the clinical pattern and biochemical abnormalities, andafter exclusion of secondary causes of hypokalemia, and after exclusion of AndersenTawilsyndrom,diagnosis of FHPP (Westphall disease) was made. Her parents’ examination andelectroneuromyogram were normal. Conclusion Diagnosis of FHPP rests upon excluding secondarycauses of hypokalemia. Intermittent attacks and normal potassium values in between attacks lead toa primary cause. The diagnosis requires confirmation by a molecular genetic test (pathogenicmutation in CACNA1S).


ID : 200195


TITLE : EPIDEMIOLOGY, CLINICAL AND ELECTRONEUROMYOGRAPHIC FEATURES OFAMYOTROPHIC LATERAL SCLEROSIS IN SENEGAL

Author : Daniel Gams Massi [1] , Japhari Nyassinde [1] , Moustapha Ndiaye [1] , Amadou GalloDiop [1] , Mouhamadou Mansour Ndiaye [1] , Kamadore Touré [2]

Affiliation : [1]Cheikh Anta Diop University Fann national teaching hospital, [2]Thiès University


ABSTRACT : Amyotrophic lateral sclerosis (ALS) is a severe neurodegenerative disorder leading tothe loss of upper and lower motoneurons. It is the most frequent motoneuron disease. Many studieshave been done in the world, but there is no current data in Senegal. The aim of this study was todetermine epidemiology, clinical and electroneuromyographic features of ALS in Senegal. Weconducted a cross sectional study from November 2015 to November 2016 in the neurosciencesdepartment of Fann National Teaching Hospital. We enrolled 20 ALS patients (14 males, 6 females)diagnosed based on Modified El Escorial criteria after completing the consent form. The mean agewas 45.5 +/ 15.8 years old (20 70). Patients came frequently from the rural area and were mainlyexposed to pesticides and insecticides, in 2 patients we found parent’s consanguinity. No family casewas found. Clinically, the mean age of symptoms onset was 42.7 +/ 16.7 years old and startedmainly in the upper limbs (70%). The classical clinical features were present in all patients, but wehave found atypical signs like dysesthesia in 2 patients. The electroneuromyogram was contributiveand the brain and cervical MRI was normal in all cases. Due to the low availability of Riluzole inSenegal, the patients received vitamin E and supportive care. In conclusion, ALS is also present inSenegal, with the same features as many studies found worldwide. Further studies should be done todetermine the genetic features and outcome of patients. Keywords: ALS; Modified El Escorial criteria;Senegal


ID : 200196


TITLE : PRéVALENCE ET FACTEURS ASSOCIéS à LA CéPHALéE DE TENSION (CT) ENPOPULATION GéNéRALE à COTONOU, BéNIN.

Author : GNONLONFOUN Dieu donné [1] , ADJIEN Constant [1] , GOUDJINOU Gérard [1] , WEKENobel [1] , HOTCHO Corine [1] , NYANGUI MAPAGA Jennifer [1] , EKUE Wilfried [1] , DOVOEDONelly [1] , HOUINATO Dismand [1]

Affiliation : [1]CNHUHKM

TOPIC : Other

ABSTRACT : Introduction : La CT est une affection neurologique fréquente très peu étudiée auBénin. Objectif : Etudier la prévalence et les facteurs associés à la CT en population générale àCotonou. Méthode : Etude transversale, prospective, descriptive et analytique qui s’est déroulée deseptembre à Octobre 2015, qui a porté sur 1050 sujets échantillonnés par la technique de sondageen grappe. Le diagnostic de CT reposait sur les critères IHS 2004. La variable dépendante était laCT. Les variables indépendantes étaient l’âge, le sexe, l’ethnie, le niveau d’instruction, la profession,le statut matrimonial et la religion. Le logiciel EPI info 7.1.5.0 a servi de base à l’analyse des données.Résultats Sur les 1050 sujets enquêtés, 261 présentaient une CT soit une prévalence de 24,8%. Ilsétaient âgés de 29,8 ± 13,9 ans [1592 ans]. La prévalence était de 58,1% chez les hommes, de29,6% chez les élèves/étudiants et de 76,5% chez les sujets instruits. Les facteurs associés retrouvésétaient la profession (p=0,01), le statut matrimonial (p=0,02) et le niveau d’instruction (p=0,02).Discussion/Conclusion La CT est une céphalée primaire assez fréquente dans notre communauté. Ils’agit d’une affection qui est à l’origine d’un nombre élevé d’absentéisme au travail. Dans leclassement OMS des causes d’invalidité, les CT figurent parmi les 10 plus affections invalidantespour les deux sexes. Il est donc nécessaire de bien codifier la prise en charge pour qu’elle soitefficace et efficiente. Mots clés : Céphalée de tension, prévalence, Bénin.


ID : 200197


TITLE : INTRAMEDULLARY ABSCESS REVEALED BY A SPASTIC PARAPLEGIA IN A 15MONTHSOLD INFANT ABOUT AN OBSERVATION

Author : Marcellin Bugeme [1] , Laila Belarabi [1] , Alioune Badara Thiam [1] , AboubakarNahantchi [1] , Salaheddine Mourabit [1] , Moustapha Ndiaye [1] , Mouhamadou Mansour Ndiaye [1]

, Kamadore Toure [2]

Affiliation : [1]Cheikh Anta Diop University Fann national teaching hospital, [2]Thiès University


ABSTRACT : The intramedullary abscess is an exceptional localization. It’s often the cause ofdiagnostic problems. MRI is highly needed, and allows for early diagnosis. The authors report anobservation of a 15monthsold infant admitted for motor deficiency of the lower limbs withprogressive installation in a febrile context and in whom clinical examination found spastic paraplegia,kyphosis of the dorsal spine with slight hyperchromic swelling, surrounded by a pilosity in thedermatomes T3T4, making us suspect a dermal sinus. Spinal cord MRI revealed a pseudotumorprocess and a tract that communicate the collected lesion to the skin. A neurosurgical interventionwas performed and confirmed the existence of the dermal sinus, as well as an intramedullary abscessthat was drained and whose culture isolated a Staphylococcus aureus. After surgery and antibiotics,the evolution was good with a partial recovery of the limb motricity. Keywords: Intramedullaryabscess dermal sinusDakar


ID : 200198


TITLE : CEREBRAL INFARCTION IN YOUNG ADULT AT THE NEUROSCIENCES DEPARTMENT OFDAKAR

Author : Japhari Nyassinde [1] , Daniel Gams Massi [1] , Moustapha Ndiaye [1] , Amadou GalloDiop [1] , Mouhamadou Mansour Ndiaye [1] , Kamadore Toure [2]

Affiliation : [1]Fann National Teaching HospitalCheikh Anta Diop University, [2]Thies University


ABSTRACT : Introduction: Cerebral infarction (CI) accounts for about 80% of strokes and mostcommonly occurs in the elderly. Although it is not rare in young adults. Aims and Objectives Describethe epidemiology, diagnostic and outcome of CI in young adult of Senegal. Methods: This was aretrospective 2year study from January 1st, 2014 to December 31th, 2015. All patients between theages of 17 and 45 hospitalized for CI were included. Sociodemographic, clinical, etiological andoutcome data have been recorded. Results: We enrolled 50 cases in a total of 451 CI patients(10.9%). The mean age was 35 years ± 8 and the sex ratio was 1.7 in favor of male. The main riskfactors found were high blood pressure (20%), smoking (10%) and diabetes mellitus (6%).Concerning etiology, cardiac disease accounted for 24%, atherosclerosis 16% and other causes 2%.No etiology was found in 60% of the cases. The mortality rate was 22%. Discussion: CI in youngadults represents 10 to 15% of the CI. In the developing countries cardiac disease are the maincauses and the carotid dissections are exceptional. The high frequency of unknown causes must alsobe noted because of the difficulty to perform some investigations. The mortality remain inferiorcompared to elderly. Conclusion: CI in young adults are common and in developing countries andhighlight the problem of etiologic diagnosis and functional outcome. Key words: Cerebral infarction,young adult, developing countries. No conflict of interest


ID : 200199


TITLE : LA CRYPTOCOCCOSE NEUROMENINGEE (CNM) EN NEUROLOGIE : TENDANCESEPIDEMIOLOGIQUES, CLINIQUES, THERAPEUTIQUES ET EVOLUTIVES DE 2012 A 2016

Author : Constance Apo YAPOEHOUNOUD [1] , Christian Abel TANOH [1] , Muriel AMONTANOH[1] , Cédric ClaudeValery KADJO [1] , Roger Yao BENE [1] , Evelyne AKAANGHUI DIARRA [1] , Berthe ASSI [1] , Thérèse SONAN [2]

Affiliation : [1]service de Neurologie CHU de Cocody,Abidjan, [2]service de Neurologie CHU deYopougon,Abidjan


ABSTRACT : Introduction La cryptococcose neuroméningée constitue la 3e infection opportunisteneurologique sur terrain VIH. En 2012 elle représentait 0,46% des hospitalisations , avec une létalitéde 75%. Objectifs Décrire les tendances observées dans la prise en charge des patients atteints deCNM depuis 2012 jusqu’en 2016. Résultats La CNM représente 0,32% de l’ensemble deshospitalisations avec une prédominance féminine (72%) et une sérologie VIH positive (100%) en2016. Le diagnostic a reposé sur un syndrome méningé franc fébrile (100%) couplé aux anomaliesLCR classiques. Cependant 22% des patients avaient une culture négative, malgré l’examen direct etdes Ag solubles positifs. Jusqu’en 2012, l’amphotéricine B était le traitement en vigueur (34%), mais ila été délaissé , au profit du fluconazole. Tous les patients ont donc reçu ce dernier et l’ont bien toléré(89%). La comorbidité la plus observée était la tuberculose (44%).La mortalité était de 78% (contre75% en 2012) au bout de 3 semaines d’hospitalisation en moyenne. Discussion La prévalence de laCNM reste constante depuis 4 ans, bien que faible et demeure l’apanage de la femme jeune etactive. L’actualité réside dans la discordance clinicobiologique observée dans notre étude qui sejustifierait par les techniques d’examens réalisées (test au LBA ) mais aussi dans le choixthérapeutique (fluconazole) car mieux toléré. Malgré tout la CNM demeure toujours, de pronosticredoutable. Conclusion Il convient d’harmoniser au plan national les habitudes de prescription dans laCNM, tout en mettant toujours l’accent sur la prise en charge globale de l’infection à VIH. Mots clés :cryptococcose neuroméningée, traitement.


ID : 200207


TITLE : LIFE QUALITY OF THE MIGRAINOUS PATIENTS: A WEST AFRICAN SURVEY

Author : Diagne Ngor Side [1] , Soumaila Boubacar [2] , Ndiaga Matar Gaye [2] , Maouly Fall [2] , Amadou Gallo Diop [2] , Moustapha Ndiaye [2] , Mouhaadou Mansour Ndiaye [2] , Chavi M [3] , Dady Sami Mohamed [3] , Abou Sy [4]

Affiliation : [1]Department of Physical Medicine, Fann National Teaching Hospital, Dakar Senegal, [2]Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal, [3]Department ofNeurology, Hospital of the specialities, Nouakchott, Mauritania, [4]Department of Psychiatry, FannNational Teaching Hospital, Dakar, Senegal

TOPIC : Other

ABSTRACT : Migrainerelated disability is multidimensional and is poorly appreciated by thediagnostic criteria of the International Society of Headache. The Headache Impact Test6 (HIT 6) andthe Migraine Disability Assessment Questionnaire (MIDAS) are the main scales validated in order toassess the burden associated with migraine. We wanted through this study prospective, transversal,determine the disability associated with migraine in the Mauritanians. The study concerned migrainepatients according to the criteria of the International Society Of Headache (2013), accepting anytreatment. The impact of the disease has been appreciated by the MIDAS and HIT6 scales. Seventyfour (74) migraine have been included. The average age was 30 years and the sex ratio of 3.6 (F/H).All patients have noted a decrease in productivity in relation to migraines. The loss of productivity perquarter was more than 20 days in 78.60% of cases, between 10 and 20 days in 11,80%, 610 days in6.20% and less than 6 days in 3.40. %. The impact of migraine was major in 90, 54% of migraineursaccording to the HIT6. The impact of migraine on the quality of life of the Mauritanian patient is huge.Due to the high productivity loss, migraine can be an impediment to the development where the needto encourage physicians to training on the management of pain and put in place support unitsdedicated to pain.


ID : 200208


TITLE : LATERAL BULBAR INFARCTION: TWO CASES OF OPALSKI SYNDROME AND REVIEW OFTHE LITERATURE

Author : Mohamed Lelouma MANSARE1 [1] , Daniel Gams Massi1, Ibrahima Mariama Diallo1,Maha Makane1, Ngor Side Diagne1, Fodé Abass Cisse2, Moustapha Ndiaye1, Amadou Gallo Diop1,Mouhamadou Mansour Ndiaye1 [2]

Affiliation : [1]Department of Neurology, Fann National Teaching Hospital , [2]1Neurosciencesdepartment of Fann national teaching hospital, DakarSenegal. 2Neurology department of IgnaceDeen teaching hospital, ConakryGuinea.


ABSTRACT : Ischemic stroke involving the artery of lateral bulbar fossa are rare and realize thesyndrome the Opalski syndrome. It is a diagnosis and therapeutic emergency due to the possibilitiesof thrombolysis until 12h.We report two cases of left bulbar infarction attributed to occlusion of theartery of the lateral bulbar fossa admitted in our department. These patients presented clinical signsof Opalski syndrome, which usually include Wallenberg syndrome, pyramidal syndrome and/orClaude Bernard Horner signs. The first patient was aged 60 years and had past history of high bloodpressure and diabetes followed for 5 years. He was admitted 12h after the onset of stroke. HisABDC2 score for a new vascular event was estimated at day 2 (8.1%) and day 7 (11.7%). The secondpatient was aged 56 years no known past medical history. She had presented, over 3 days, 5episodes of transient ischemic attacks before her admission. Her ABDC2 score for a new vascularevent was estimated at day 2 (4.1%) and day 7 (5.9%). The two cases presented different clinicaloutcomes: favorable for the first case with a modified Rankin score of 3/6 due to early managementand unfavorable for the second case received late to score 3/6.The brain MRI performed wasimportant for the diagnosis and facilitated the management. It should be noted after the analysis ofthe clinical outcome of our patients that the degree of risk involved depends on the combination of thecardiovascular risk factors considered and the early or late management.


ID : 200209


TITLE : LES ACCIDENTS VASCULAIRES CéRéBRAUX AU BURKINA FASO.

Author : Christian NAPON [1] , Anselme DABILGOU [1] , Julie KYELEM [1] , Jean KABORE [1]

Affiliation : [1]CHU Yalgado OUEDRAOGO


ABSTRACT : Introduction Les AVC constituent la première cause de handicap acquis de l’adulte et latroisième cause de mortalité dans le monde. Notre objectif était de dresser l’état des lieux de cettepathologie au Burkina Faso. Méthodologie Il s’est agi d’une étude rétrospective couvrant la périodedu 1er janvier 2009 au 31 décembre 2015. Elle a porté sur les patients admis dans le seul service deneurologie du pays au sein du CHU Yalgado Ouédraogo de Ouagadougou. Une confirmationdiagnostique par la tomodensitométrie cérébrale était requise. Résultats Un total de 2486 patientsAVC a été colligé avec un âge moyen de 57,7 ans et un sex ratio de 1,47. L’hypertension artérielleétait le facteur de risque le plus fréquent, retrouvée dans 54,18 % des cas. Le principal signe étaitreprésenté par l’hémiplégie dans 70 % des cas suivi par les troubles du langage dans 44,46 %. LesAVC ischémiques étaient les plus fréquents dans 59 % des cas avec 1,65 % de cas de transformationhémorragique tandis que les AVC hémorragiques comptaient pour 39 % des cas. Sur le plantopographique l’atteinte siégeait le plus souvent, pour les AVC ischémiques dans le territoire del’artère cérébrale moyenne (70 %), et pour les hémorragies cérébrales dans les régions profondes(capsule interne, thalamus et noyau lenticulaire). Conclusion Les AVC constituent un problème desanté publique dans notre contexte. Des actions de préventions doivent être menées pour luttercontre les facteurs de risque afin de réduire la morbimortalité de cette pathologie. Mots clés : AVC Burkina Faso


ID : 200210


TITLE : SUIVI DE L’éTAT NUTRITIONNEL DES PATIENTS AYANT PRéSENTé UN AVC AU BURKINAFASO

Author : Christian NAPON [1] , Jeoffray DIENDERE [1] , Anselme DABILGOU [1] , Julie KYELEM [1], Jean KABORE [1]

Affiliation : [1]CHU Yalgado OUEDRAOGO


ABSTRACT : Introduction Les AVC peuvent avoir un impact sur l’état nutritionnel des patients avecpour conséquences une augmentation des comorbidités voire même de la mortalité. Notre objectifétait de suivre l’état nutritionnel des patients hospitalisés pour AVC dans notre contexte d’exercice.Méthodologie Nous avons réalisé une étude de cohorte prospective de 128 patients sur une périodede six mois de janvier à juin 2016. Il s’agissait de patients AVC vigiles admis dans les 96 heures aumaximum suivant la survenue de l’AVC. Les paramètres anthropométriques ont été utilisés pourapprécier l’état nutritionnel des patients. Résultats L’âge moyen était de 60,4 ans et le sex ratio de1,04. Le délai moyen d’admission était de 24 heures. L’AVC était ischémique dans 57 % des cas ethémorragiques dans 43 %. Les troubles de la déglutition étaient présents dans 37,5 % des cas. Ladénutrition touchait 20,31 % des patients à J0, 24,44 % à J8 et 30,39 % à J14. Les complicationsinfectieuses étaient les plus fréquentes , pulmonaires dans 31,25 % et urinaires dans 25 %. Lamortalité était de 29,80 %. La durée moyenne du séjour de 9,64 jours. Conclusion Les AVC et lestroubles de la déglutition sont souvent associés. Ces troubles de la déglutition sont les plus grandspourvoyeurs de dénutrition chez le patient AVC dès la première semaine. Il est donc important de lesdépister et de les prendre en charge au plus tôt pour éviter d’engager davantage le pronosticfonctionnel et vital des patients. Mots clés : AVC Dénutrition Burkina Faso


ID : 200216


TITLE : EPILEPSIE à PAROXYSME ROLANDIQUE DE L’ENFANT : A PROPOS DE 27 CAS SUIVISAU SERVICE DE NEUROLOGIE DU CENTRE HOSPITALIER UNIVERSITAIRE YALGADOOUéDRAOGO (CHUYO).

Author : Lengané YTM [1] , Kyelem JMA [1] , Dabilgou A [1] , Napon C [1] , Kabore J [1] , MillogoA [2]

Affiliation : [1]Service de Neurologie, Centre Hospitalier Universitaire Yalgado Ouédraogo(Ouagadougou, Burkina Faso), [2]Service de medicine interne, Centre Hospitalier UniversitaireSourô Sanou (BoboDioulasso, Burkina Faso)

TOPIC : Epilepsy

ABSTRACT : Buts : étudier les aspects clinique et thérapeutique des épilepsies rolandiques.Méthodes : collecte de 27 cas d’épilepsie rolandique parmi 121 patients suivis pour épilepsie dejanvier 2015 à Octobre 2016. Résultats : 22,31% des patients suivis pour épilepsie. L’âge moyen despatients était de 8,44 ans, le sexe ratio de 1,7. L’âge de début de la maladie est en moyenne de 3,96ans ± 4,11 ans. La majorité des patients (26,63% des cas) présentait des crises généralisées tonicocloniques, suivi des crises motrices brachiofaciales (22,22% des cas) puis des clonies buccales(7,40% des cas). Les crises étaient nocturnes dans 29,62% des cas, diurnes et nocturnes dans11,11% des cas, matinales dans 3,70% des cas; l’horaire n’était pas précisé dans 55,55% des cas.Une souffrance fœtale aiguë était notée chez 7,4% des cas et une épilepsie familiale dans la mêmeproportion. L’électroencéphalogramme retrouvait des anomalies paroxystiques centrales ou frontocentrales avec une prédominance hémisphérique unilatérale. L’imagerie cérébrale, réalisée dans40,74% des cas (scanner dans 29,63% des cas), est revenue normale. La monothérapie était larègle. Les molécules les plus utilisées étaient le valproate de sodium (80%), la lamotrigine (12%) et lephénobarbital (8%). L’évolution était marquée par l’amendement des crises dans 44,44% des cas,leur réduction dans 25,92% des cas et la persistance des crises dans 3,70% des cas. Conclusion : lesaspects clinique et électroencéphalographiques des épilepsies rolandiques sont charactéristiques.Une évolution favorable sous monothérapie est de règle. Mots clés : épilepsie rolandique, enfant,Burkina Faso.


ID : 200217


TITLE : SPONTANEOUS INTRACEREBRAL HEMORRHAGE: PLACE OF NEUROSURGERY

Author : Mariétou Traoré [1] , Mbaye Thioub [2] , Magatte Mbaye Ndour [2] , Alioune BadaraThiam [2] , Ndaraw Ndoye [2] , Momar Code Ba [2] , Seydou Boubacar Badiane [2]

Affiliation : [1]Neurosciences department of Fann national teaching hospital Cheikh Anta DiopUniversity, [2]Neurosurgery department of Fann national teaching hospital Cheikh Anta DiopUniversity


ABSTRACT : Hemorrhagic stroke accounts for 1015% of all strokes. They are frequently attributedto high blood pressure (HBP) and their prognosis is often reserved. The aim of this study was toidentify epidemiological, clinical features and to study the various aspects of the management ofspontaneous intracerebral hemorrhage (ICH). This was a retrospective and prospective studyconducted from January 2010 to October 2014 at the Neurosurgery Department of the Fann NationalTeaching Hospital, which included all patients admitted for ICH confirmed by a brain CT scan. Sixtythree patients were included. The main complains for admission were headache and alteredconsciousness. The most affected age group was 6070 yearsold (30%). Female sex represented52.38%. HBP was the main risk factor (39.7%). Hemispheric localization was the most frequent(77.78%). Intraventricular hemorrhage was found in 69.8% of cases. The main etiologies was highblood pressure (33.33%) and vascular malformations (28.57%). The indication for surgery was(45.55%) and included mainly external ventricular drain (EVD), aneurysm clipping, and arteriovenousmalformation resection. Postoperative survival was estimated at 51.72%, mortality after surgery was48.28% with a survival time in most cases between 110 days. The average cost of the managementranged from 70,000 to 2,114,000 CFA francs. Despite the increasing progress of intensive care unit,few therapeutics improve the prognosis of patients and the place of surgery remains poorly defined. Apolicy of screening and controlling the main risk factors such as high blood pressure wouldundoubtedly reduce the morbidity and mortality of stroke in Senegal. Key words: ICH, HBP, mortality


ID : 200219


TITLE : UNUSUAL CLINICAL FEATURE OF A FLAIL ARM SYNDROME: A CASE REPORT

Author : SALMI [1] , CHELGHOUM [2] , SERRADJ [2] , HAMRI [2]

Affiliation : [1]neurology clinic, Constantine, [2]

TOPIC : Other

ABSTRACT : We describe a case of a 48year old patient diagnosed with amyotrophic lateralsclerosis. The clinical findings, a drooping head with symmetric, proximal wasting and weakness ofboth arms leading to severe functional disability and contrasting with preserved independentambulation and sparing of bulbar muscles, were consistent with the proposed criteria of the socalledflail arm syndrome, variant of ALS. He has installed, quickly, respiratory disorders and its death after02 months of the onset of the disease.


ID : 200222


TITLE : TITLE: RISK FACTORS AND PATTERN OF STROKE IN BENGHAZI MEDICAL CENTER

Author : Mabroka Agiela [1]

Affiliation : [1]


ABSTRACT : Background/Aim: Stroke is a common neurological disorder, the second commonestoverall cause of death,and a major cause of disability in survivors. Stroke is largely preventable, sothat knowledge of risk factors is essential to achieve reduction in the stroke rate&resulting diseaseburden . Methods : Cross sectional study conducted at Benghazi medical center between 20112013from neurology out patient clinic & admission record regarding clinical presention of stroke, history ofchronic disease, age, sex ,laboratory data of CBP,PT , APTT , lipid profile , ECG , ECHO ,carotiddoppler and CT / MRI . To recognize the risk factors and subtypes of cerebrovascular disease .Results: 130 patients of stroke; 70 are male , 60 female with mean age (61.5 ST.D 12.7 ) , 33.8%present with right side weakness ,28.5% left side weakness . Hypertension association accountingfor 74.6% of cases , diabetes: 34.6% , cardiac diseases 21.5% , previous stroke20%,hyperlipidemia4.6% and cigarette smoking 8.5% . stroke subtypes : ischemia 48%, lacunarinfarction 31% , and haemorrage 21% . Conclusion: Hypertension is the most frequent risk factor forstroke which require more health care attention and focus also increase lacunar infarction whichmerits further investigation population risk factor( undiagnosied or poorly controlled HTN & D.M ).


ID : 200224


TITLE : FRONTAL PRESENTATION OF ALZHEIMER’S DESEASE

Author : Daoud Sawsan [1] , Farhat Nouha [1] , Hadj Kacem Hanène [1] , Hdiji Olfa [1] , DammakMariem [1] , Mhiri Chokri [1]

Affiliation : [1]Neurology department , Habib Bourguiba University Hospital, Sfax Tunisia.

TOPIC : Alzheimer's disease and other dementias

ABSTRACT : Introduction Besides its typical amnesic presentation, focal atypical presentations ofAlzheimer’s disease (AD) have been described, such as frontal variant. It’s a rare phenotypedescribed in patients presenting prominent behavioural deficits. Methods: We report a serie of threepatients who were diagnosed with frontal variant of AD. We described their clinical andneuropsychological profils. All frontal AD patients were evaluated with the neuropsychiatric inventory(NPI). Cerebrospinal fluid (CSF) samples were col¬lected by lumbar puncture and analyzed. ALLpatients had a Brain MRI and FDG PET. RESULTS The age at onset of symptoms was 80 years. Atthe onset of the disease, All patients had predominantly inert behavior presentation.Neuropsychological tests showed an impairment in global cognitive efficiency (MMSE 15/30). Therewas an episodic memory deficit characterized by a low free recall (free recall score=1/10) notnormalized with cueing (total recall=1/10). Dysexecutive deficits were present in all patients (BREFTest = 8/18). Verbal fluencies were re¬duced, both in phonemic (score = 2/28) and categoricalmodalities (score = 2/ 28). Our patients were evaluated with the NPI. All of them had severebehavioral and psychological Symptoms (Global score = 44/ 144). Brain SPECT showed moderatehypoperfusion in dorsolateral prefrontal cortex. CSF biomarkers were available and showed low Aβ42(329 pg/mL), high Tau (1073 pg/mL) and high PTau (97 pg/mL). CONCLUSION By usingphysiopathological markers, such as CSF markers, it is now possible to establish a biologicaldiagnosis of AD in these focal cortical syndromes, and to propose a specific treatment for them.


ID : 200226


TITLE : THE NORMATIVE VALUES OF ENMG IN A HEALTHY VOLUNTEER POPULATION

Author : Chraa Mohamed [1] , Jalami Nezha [1] , Kissani Najib [1] , Choulli Mohamed Khaled [2]

Affiliation : [1]Mohammed VI university hospital, [2]Medical school of Marrakech


ABSTRACT : Introduction: ENMG is essential for the study of the peripheral nervous system andcontribute to the diagnosis, and prognosis in the disease of the latter. Aims and Objectives: Ourobjectives in this study are to establish the normative values of nerve conduction for ourneurophysiological through a sample of 50 subjects of different sex and age. Methods: A crosssectional prospective study, recruiting the maximum possible number of healthy volunteersconstituting a representative sample of the population studied. Results: Our study came up withvaluable results concerning the velocity, amplitude and latencies of the main nerves studied in ourroutine practice. we included the lowest highest and mean value for each nerve. we studied themotor, sensitive conductions and F wave. An exemple of our results is the median nerve where theamplitude at the wrist level was at least 4 but with a mean of 10 mv, and a velocity wirst/elbow of atleast 45 m/s. All the other results will be presented in the main work. Discussion: By comparing ourresults of nerve conduction with those of other studies in the literature, we have specifically chosenstudies with techniques similar to ours and respecting one of the variables studied in our work.Conclusion: This study allowed us to establish the normative values in electromyography for theperipheral nerves most commonly examined. Now, and thanks to this study, our neurophysiologicallaboratory has its own normative values of nerve conduction .


ID : 200228


TITLE : THYROTOXIC PERIODIC PARALYSIS: UNCOMMON DIAGNOSIS IN ACUTE TETRAPLEGIA

Author : Hela Mnif [1] , Amal Arous [1] , Anis Hessine [1] , Salma Naiija [1] , Sana Ben Amor [1] , Sofien Benammou [1]

Affiliation : [1]departement of neurology, Sahloul Hospital, Tunisia


ABSTRACT : Introduction: Hypokalemic Periodic paralysis (HPP) is a rare but lifethreatening causeof flaccid tetraplegia. When it is secondary to thyrotoxicosis, it is called thyrotoxic periodic paralysis(TTP). Since, the features of thyrotoxicosis may be subtle or absent at presentation, physiciansshould consider TTP in patients with tetraplegia and hypokalemia. TPP is most commonly seen inAsian men but is rare in North Africans. Observation: We report the case of a 26year old Tunisianmale with no significant past medical history. He presented to the emergency with acute weakness inall 4 limbs, which resolved after hypokalemia adjustment. With the presence in our patient of weightloss and tremor, we performed measurement of TSH and fT4 to confirm hyperthyroidism. He wasdiagnosed with Thyrotoxic Periodic Paralysis. Conclusion: early diagnosis of TPP is critical to avoidover correction of potassium and cardiovascular and respiratory complications


ID : 200240


TITLE : LES TROUBLES DE LA DéGLUTITION CHEZ LES VICTIMES D’ACCIDENTS VASCULAIRESCéRéBRAUX EN PéRIODE AIGUE AU BURKINA FASO.

Author : Christian NAPON [1] , Modeste LENGANE [1] , Anselme DABILGOU [1] , Julie KYELEM [1], Jean KABORE [1] , Jeoffray DIENDERE [2]

Affiliation : [1]CHU Yalgado OUEDRAOGO, [2]Centre Muraz


ABSTRACT : Introduction : l’objectif de notre étude était d’évaluer la fréquence des troubles de ladéglutition (TD) et leur évolution temporelle dans les deux premières semaines chez les patientsvictimes d’accident vasculaire cérébral. Méthodologie : étude de cohorte prospective en utilisant untest au lit du malade à J0, J8 et J14, chez 128 patients reçus dans les 96 heures de l’évènement, du07 Janvier au 07 Juin 2016. Résultats : l’âge moyen était de 60,64±13,22 ans. Le sex ratio était de1,09. L’aphasie concernait 64 (50%) patients et était corrélée à un plus haut risque (p=0,0000). Ledéficit moteur était du côté droit chez 71 (55,46%) patients. A l’admission, les TD étaient retrouvéschez 48 (37,5%) patients parmi les 128 inclus. Au huitième jour, les TD étaient retrouvés chez 29(26,61%) parmi les 109 patients survivants. A la dernière évaluation à J14, les troubles de ladéglutition persistaient chez 15 (14,71%) patients parmi les 102 survivants. Les pneumopathies ontété retrouvées chez 33 (65,75%) des patients avec TD. La durée moyenne de séjour était de 9,64jours. La mortalité est multipliée par 7 en cas de TD. Conclusion : les TD sont fréquents en périodeaiguë d’accident vasculaire cérébral et régressent habituellement dans les 14 premiers jours. Ilsaugmentent la morbidité et la mortalité au cours des AVC. Mots clés : troubles de la déglutition,accident vasculaire cérébral, pneumopathies, Burkina Faso.


ID : 200242


TITLE : LES PHACOMATOSES à PROPOS DE DEUX CAS AU SERVICE DE NEUROLOGIE DUCENTRE HOSPITALIER UNIVERSITAIRE YALGADO OUEDRAOGO, BURKINA FASO

Author :

Affiliation :

TOPIC : Other

ABSTRACT : Introduction Les phacomatoses désignent un groupe de dysplasies neuroectodermique. Nous rapportons deux cas d’épilepsie de l’enfant liée à une phacomatose.Observation 1 : Il s’agissait d’une patiente de 15ans qui a consulté pour des crises généraliséestonicocloniques. L’examen neurologique était normal, au niveau cutané on notait des angiofibromesfaciaux, des plaques maculeuses hypochromiques plissées au niveau dorsal et fessier.L’électroencéphalogramme était normal. L’IRM cérébrale montrait des tubers siégeant au niveausous épendymaire au niveau des ventricules latéraux et des lobes temporaux internes se rehaussantfortement après injection de gadolinium. La biopsie cutanée montrait un épithélium malpighienkératinisant avec des atypies, une fibrose dense et épaisse de fibre collagène associée à devolumineux lobules sébacés au niveau du derme. Le diagnostic de sclérose tubéreuse de Bournevilleétait retenu. Observation 2 : Il s’agissait d’un patient de 5 ans, reçu pour des troublescomportementaux et des crises généralisées tonicocloniques évoluant depuis la naissance.L’examen retrouvait une hémiparésie gauche, un angiome plan cutané droit de la face. Le patientprésente un déficit cognitif avec des troubles de comportement à type d’hyperactivité, d’écholalie.L’électroencéphalogramme montrait des activités paroxystiques rolandiques et occipitaleshémisphérique droite. L’IRM cérébrale objectivait une atrophie corticosous corticale temporopariétooccipitale droite, un élargissement des veines profondes et des plexus choroïdiens droits, une prisede contraste gyriforme pariétooccipitale droite. Le diagnostic de syndrome de SturgeWeber étaitretenu. Conclusion : Les phacomatoses sont des maladies rares. L’IRM cérébrale est un examencomplémentaire important pour la caractérisation des différentes formes de phacomatoses


ID : 200246


TITLE : FIRST REPORTED SUDANESE PATIENT WITH A MIGRAINE STROKE

Author : Sarah Misbah ElSadig [1]

Affiliation : [1]University of Khhartoum, Faculty of Medicine


ABSTRACT : A 40 year old Sudanese engineer who works between Saudi Arabia and Sudan withhistory of severe migraine for more than 20years in the form of unilateral headaches alternating. Hegets the attack every 34 months. He is not known diabetic or hypertensive and smokes less than apack a day woke up one day with sudden loss of vision. Investigation showed a large occipital infarctand normal MRA and MRV. Most probably this is a migraine related stroke and this is the 1stSudanese patient whom we did encounter with this diagnosis


ID : 200249


TITLE : OCCIPITAL NEURALGIA DIAGNOSIS AND TREATMENT: TWO CASE REPORT

Author : Ayadi basma [1] , Kolsi Mahla [1] , KHalbous Sonia [1] , Haddad monia [1]

Affiliation : [1]CENTE E TRAITEMENT DE LA DOULEUR LA RABTA

TOPIC : Other

ABSTRACT : Introduction: Occipital neuralgia is defined by the International Headache Society asparoxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve.Various treatment methods exist, from medical treatment to open surgical procedures Cases report:Thirty seven years old male patient came with severe headache. He described that his headachesstarted 3 years ago, getting more frequent over the following weeks. The pain affected mostly leftoccipital region about 23 times a day, occurring in a sharp, transient. The patient also complainedabout mild pain on the occipital region triggered or exacerbated by touch or massaging. Cervicalcontrast magnetic resonance imaging (MR) was normal. He received a level II antalgic with mildevolution Second case Thirty years old women came with severe occipital and bilateral headachestarting 1 month ago with depressive syndrome. Cervical contrast magnetic resonance imaging (MR)was normal she received pregabalin with Antidepressant medication Discussion: Occipital neuralgia istypically idiopathic but it may also present due to secondary conditions. Various treatment methodsexist, from medical treatment to open surgical procedures. Local injection with corticosteroid canimprove symptoms, though generally only temporarily. More invasive procedures can be consideredfor cases that do not respond adequately to medical therapies or repeated injections Conclusion :Typically, there is no clear structural cause for occipital neuralgia, although appropriate workupshould be considered in order to ruleout pathologic structural causes. The occipital nerve block is avaluable, simple, and safe diagnostic and therapeutic tool that should be considered early in thecourse of treatment.


ID : 200255


TITLE : LES POLYRADICOLONEVRITES AIGUES : SYNDROME DE GUILLAINBARRE A PROPOSDE 39 PATIENTS COLLIGES AU CHNU DE FANN

Author : Basse Anna Modji [1] , Sow Adjaratou Dieynabou [1] , Ndiaye Moustapha [1] , NdongMarie Emilie [1] , Diagne Ngor Side [1] , Diop Marieme Soda [1] , Gaye Ndiaga Mactar [1] , ToureKamadore [1] , Diop Amadou Gallo [1] , Ndiaye Mouhamadou Mansour [1]

Affiliation : [1]Service de Neurologie CHU Fann, BP 5035 DakarFann, Sénégal


ABSTRACT : Introduction : Au Sénégal, les polyradiculonévrites aigues (PRNA) principalement lesyndrome de GuillainBarré affecte majoritairement les jeunes. L’objectif de ce travail est de préciserle profil épidémiologique, clinique, électrophysiologique, thérapeutique et évolutif des patients atteintsde PRNA à partir d’une série hospitalière. Patients et méthode : Il s’agit d’une étude rétrospectiveportant sur des dossiers de patients hospitalisés, entre le 1er janvier 2010 et le 30 juin 2016, auservice de Neurologie du centre hospitalier national de Fann. Résultats : Nous avons colligé 39patients dont 27 femmes (69,2%). L’âge moyen était de 33,9 ans. Un épisode infectieux a précédél’installation du tableau neurologique chez 17 patients (43,6%). Une progression ascendante dudéficit était notée chez 37 malades (94,7%) et le déficit moteur était symétrique chez 23 patients(58,9%). L’électroneuromyogramme montrait une perte axonale associée à la démyélinisation dans 9cas (27,3%). Une dissociation albimunocytologique du liquide céphalorachidien était notée chez 10patients (38,5%). La sérologie rétrovirale et l’AgHBs étaient positives respectivement chez un patient.Une corticothérapie était instaurée chez 20 patients dont 66.66% dans les formes démyélinisantes et33,33% axonomyéliniques. Trente et un patients (79,48%) présentaient des séquelles motrices à lasortie d’hospitalisation. Conclusion : Les polyradiculonévrites aigues restent une pathologie rare avecune fréquence hospitalière élevée. Une prise en charge précoce est préconisée.


ID : 200258


TITLE : DIFFICULTIES IN MANAGEMENT OF ISCHEMIC STROKE IN SUBSAHARAN AFRICA,FROM THROMBOLYSIS TO DECOMPRESSIVE CRANIECTOMY: CASE REPORT

Author : OSSOUNGUIET Paul Macaire [1] , MATALI Edgard [1] , MPANDZOU Ghislain Armel [1] , MOTOULA LATOU Dinah Happhia [1] , BANDZOUZI NDAMBA Bébène [1] , SOSSOUMIHENLudovic Landry [2] , SOUNGA BANDZOUZI Eliot Prince [3]

Affiliation : [1]Department of Neurology, University Hospital of Brazzaville, [2]Clinic Pasteur ofBrazzaville, [3]Department of Neurology, Loandjili Hospital, Pointe Noire


ABSTRACT : Introduction. Ischemic stroke has benefited in recent years an adapted management.IV thrombolysis and thrombectomy represent effective treatments in the acute phase. In Congo, theestablishment of unit stroke has permit to do 2 cases of IV thrombolysis. We report a case requiringmanagement by thrombolysis and thrombectomy, whose reflection on a decompressive craniectomywas carried out. Case. It was a 54yearold patient, obese (130 kg), hypertensive, without no otherrisk factors. Admitted on December 14, 2015 at 8:15, with sudden left hemiparesis. He benefited froma cerebral scan without injection at 10:20, that is 2:05 of the beginning. In the initial neurologicexamination the NIHSS was 18 The initial CT scans no early signs, ASPECT scale 10/10, but largethrombus of the carotid termination and M1 on the right. There is no contraindication to Thrombolysis,but thrombectomy is not available. The thrombolysis was started at 11h55, that is 2h50 of thebeginning. NIHSS score at 2 h after fibrinolysis, always at 18. At 22h, neurological aggravation,NIHSS score: 24, right unilateral mydriasis. Cerebral scan at 23:58: Malignant hemispheric infarction,always visible thrombus The reflexion on a decompressive craniectomy was carried out and rejectedbecause of the severity. Death occurred after 24 hours of evolution. Conclusion. Thrombectomyrepresents the most effective treatment of occlusion of the major arteries, but its realization requiresequipment not available in the majority of African countries, making it difficult to manage patients.


ID : 200260


TITLE : CEREBRAL INFARCT OF UNDETERMINED CAUSES IN SENEGAL

Author : Affognon kegnide christelle cadnelle [1] , Nyassinde Japhari [1] , Gams Massi Daniel [1] , Ndiaye Moustapha [1] , Diop Amadou Gallo [1] , Ndiaye Mouhamadou Mansour [1]

Affiliation : [1]Neurosciences department of Fann national teaching hospital Cheikh Anta DiopUniversity


ABSTRACT : Cerebral infarct is a severe and frequent condition in our regions. Its etiologicalinvestigation may prove difficult because of the imbrication or nonidentification of causes. Theobjective of our study was to determine the frequency of cerebral infarct of undetermined causes inpatients admitted at the neurosciences department of Fann national teaching hospital (Dakar,Senegal). This was a 27 month retrospective study from 1 January 2014 to 31 March 2016 of 519patients aged 19 to 100 years who had been hospitalized for cerebral infarct in the department. Themean age of our patients was 65.7 ± 14.6 yearsold ranged from 19 to 100 years. Among patientshospitalized for cerebral infarct, 297 (57.22%) had undetermined causes included 178 patients (60%)for unknown causes and 119 (40%) for multiple etiology. 211 cases (71%) were hypertensive and 74cases (24.9%) were diabetic. The lesions were cortical in 187 patients (63%) and deep in 110 patients(37%). The cerebral arteries concerned were: the middle cerebral artery (76%), the vertebrobasilarsystem (13%), the anterior cerebral artery (9%) and the anterior choroidal artery (2%). The highfrequency of undetermined causes of cerebral infarct may be related to limited access to someinvestigation tools and may influence optimal management of patient and secondary prevention ofischemic stroke. Key words : Cerebral infarct, Undetermined causes, Dakar


ID : 200262


TITLE : NEUROBEHCET DISEASE : ABOUT SIX SENEGALESE CASES

Author : GAYE Ndiaga Matar [1] , DIOP Marième Soda [1] , DIAGNE Ngor Side [1] , BASSE AnnaModj [1] , SOW Adjaratou Djeynabou [1] , FALL Maouly [1] , NDIAYE Moustapha [1] , DIOPAmadou Gallo [1] , NDIAYE Mouhamadou Mansour [1] , SARR Mamadou Moustapha [2] , TOUREKamadore [2] , SECK Lala Bouna [3]

Affiliation : [1]Ibrahima Pierre Ndiaye NEUROSCIENCES department of Fann Teaching Hospital, BP5035, Dakar, Senegal, [2]Thies University, Senegal, [3]SaintLouis University, Senegal


ABSTRACT : Introduction. The prevalence of neuroBehçet (NB) varies between 5.3 and 50 per cent.Contrary to what happens in North Africa, rare cases are reported in subSaharan Africa. The aim ofthis study is to analyze epidemiological, clinical, radiological and therapeutic aspects of NB in Fannteaching hospital, Dakar, Senegal. Method. It was a retrospective and descriptive study (01 July 2012 30 June 2016) which included all senegalese patients corresponding to the NB diagnostic criteria.Our selection was done among the hospitalized patients in infectious diseases and neurologydepartments. Results. Six cases of NB were collected. All these patients were men and the mean agewas 35 years (22 59). Headaches (5/6) and pyramidal syndrome (6/6) were the most frequentsymptoms. The main extraneurological expressions were fever (5/6) and aphtose (6/6). In 3 patients,the recurring bipolar aphtose comes before the neurological symptoms. Clinical forms were asepticmeningoencephalitis, retrobulbar optic neuritis, cerebral venous thrombosis, myelitis andrhombencephalitis. Discussion. NB is a serious disease because it can influence the vital andfunctional prognosis. It is more often noticed in Arabic countries and in the western part of theMediterranean area. In our patients, neurological symptoms are either the entry mode into thedisease or the first reason to get consulted by a specialist. The research for recurring aphtose shouldbe systematic in neurological practice. Conclusion. A multilevel and longterm study is necessary tobetter grasp the NB aspects in Black African countries.


ID : 200263


TITLE : PURE MIDBRAIN INFARCTION

Author : Ben Hmidene Manel [1] , Messelmani Mariem [1] , Zaouali Jamel [1] , Riahi Anis [1] , Mansour Malek [1] , Mrissa Ridha [1]

Affiliation : [1]Department of Neurology, MilitaryHospital, Tunis, Tunisia


ABSTRACT : Introduction: Midbrain stroke syndromes are uncommon in clinical practice. They areusually associated with the concomitant involvement of other structures, such us the thalamus, pons,and cerebellum. The infarction limited to the midbrain is rare. Methods: We studied 4 patientsadmitted to the department of neurology of the military hospital of Tunisia between 2012 and 2016,and diagnosed as having pure midbrain infarction based on clinical characteristics and magneticresonance imaging (MRI) findings. Result: Four patients with pure midbrain infarction were enrolled inthis study. The sex ratio (F/M) was 1/1. The mean age was 42 years [3256 years]. Patients had nomedical history. Clinical features varied depending on the location of the lesion. We identified 2 casesof Claude’s syndrome; one case of Weber’s syndrome and one case of Parinaud’s syndrome. Onewoman has a newly diagnosed atrial fibrillation. Etiologic investigation of ischemic stroke foundHyperhomocysteinemia in one patient. No etiology of the stroke was found in two patients.Conclusion: As isolated midbrain infarction is uncommon, specific ocular motor signs, mainly thirdnerve palsy, may help to identify and localize the mesencephalic infarct. A diagnostic workup shouldbe performed to detect the causal mechanism.


ID : 200266


TITLE : YOUTH IN NEUROSCIENCE TRAINING IN AFRICA

Author : Daniel Gams Massi [1] , Belarabi Laïla [1] , Magnérou MélanieAnnick [1] , NgoungoureHalima Fidélie Scholastique [1] , Ndiaye Mouhamadou Mansour [1]

Affiliation : [1]Neurosciences department of Fann national teaching hospital Cheikh Anta DiopUniversity

TOPIC : Hot topics in neurological sciences

ABSTRACT : Symposium Description: Nervous system disorders are increasingly prevalent due toincreased life expectancy, industrialization of countries, changes in lifestyle and a continuous rising ofinfectious diseases. Faced with this, several initiatives have been taken on both neuroscience trainingand research in the world. However, in Africa, efforts are still needed to increase the number ofneuroscientists and give them appropriate tools to better manage all these conditions. The objectiveof this symposium is to make an inventory of the training of young Africans in neuroscience regardingfour main topics: • Neurovascular pathology and the difficulty of setting up stroke units (SU). •Epilepsy and the difficulty of setting up diagnostic, care and research centers and fellowship for youngneuroscientists. • Infectious pathology, especially HIV especially the difficulties and limited researchon Brain and HIV. • Neuromuscular pathology and availability of structures and training in clinicalneurophysiology and lack of training and research in new genetic engineering techniques. At the endof this symposium, we will propose recommendations to improve young access to training andresearch in the field of neuroscience in Africa. Key words : Neurosciences, Africa, Young


ID : 200270


TITLE : FAHR’S DISEASE: A CASE REPORT PRESENTING WITH ANXIETY AND DEPRESSIVESYMPTOMS

Author : Guermazi Fatma [1] , Baati Imen [1] , Masmoudi Jawaher [1] , Snoussi Mouna [2] , Bahloul Zouhir [2] , Bouzidi Nouha [3] , Dammak Mariem [3] , Mhiri Chokri [3]

Affiliation : [1]Department of Psychiatry “A”, Hedi Chaker University Hospital, Sfax, Tunisia, [2]Department of Internal Medicine, Hedi Chaker University Hospital, Sfax, Tunisia, [3]Department ofNeurology, Habib Bourguiba University Hospital, Sfax, Tunisia

TOPIC : Other

ABSTRACT : Objective: To report clinical and paraclinical manifestations in a patient with idiopathicbipalidal calcifications revealed in the cranial computed tomography (CT). Case report: Mr T. is a 39yearold man who had been diagnosed with recurrent depressive disorder for twelve years. Althoughhe received several antidepressant and anxiolytic medications, he still presented anxious anddepressive symptoms. Neurological examination showed no abnormality in motor and sensorialfunctions. CT visualized bilateral pallidal calcifications. In order to exclude disorders that may lead tosecondary intracranial calcification, the patient went through a series of specialized clinicalexaminations by an ophthalmologist, an internist and a geneticist. He also performed laboratory testsincluding routine hematological and urine tests, serum calcium and phosphate level, serumparathyroid hormone level, antinuclear antibodies level and serological tests for syphilis and HIV. Allthese tests were normal. A family survey did not reveal any significant family history of mental illness,dementia or any other physical illness and the father’s CT was normal. Based on the clinical andbiological data that eliminated biochemical abnormalities, infectious, toxic or traumatic causes, thediagnosis of Fahr’s syndrome due to idiopathic basal ganglia calcifications or sporadic Fahr’s diseasewas strongly suggested. Conclusion: This case emphasizes the importance of the role ofneuroimaging in patients with atypical psychiatric symptoms. The discovery of cerebral calcificationsrequires an extensive clinical and biological assessment to eliminate the potentially curable etiologies.


ID : 200271


TITLE : PRéVALENCE DES DOULEURS NEUROPATHIQUES CHEZ LES SUJETS DE PLUS DE 15ANS DANS LE TROISIèME ARRONDISSEMENT DE COTONOU

Author : ADJIEN K. Constant [1] , GNONLONFOUN Dieu donné [1] , HOUEHA Othniel [1] , HOUINATO Dismand [1]

Affiliation : [1]Clinique Universitaire de Neurologie du CNHUHKM de Cotonou


ABSTRACT : Introduction La douleur neuropathique peut être d’origine centrale ou périphériqueObjectif : Evaluer la prévalence des douleurs neuropathiques chez les sujets âgés de plus de 15 ansdans le troisième arrondissement de Cotonou. Méthode Il s’agissait d’une étude prospectivetransversale à visée descriptive et analytique qui s’était déroulée du 14 au 30 Septembre 2015. Lapremière phase était celle de l’enquête porte à porte à l’aide du questionnaire DN4 et la seconde,celle de la confirmation des cas suspects par le neurologue. L’échantillonnage était fait par grappes.Les données ont été saisies à l’aide du logiciel CsPro 4.0 et analysées par STATA 12 et SPSS 21Résultat Au total 2041 sujets s avaient été recrutés ; d’un âge moyen égal à 30,13 ± 6,76 ans. Laprévalence des douleurs neuropathiques était de 4,36%. Les caractéristiques de la douleurneuropathique les plus représentées étaient les brûlures, les picotements, les fourmillements et lesengourdissements. Les facteurs associés aux douleurs neuropathiques étaient l’âge, la profession, lediabète, la consommation chronique d’alcool et les antécédents d’AVC et de traumatisme crânien.Discussion La prévalence des douleurs neuropathiques était proche de celle trouvée par Adechina àTitirou (6,3%) dans le premier arrondissement de Parakou en 2012 au Nord du Bénin. ConclusionLes douleurs neuropathiques représentent un véritable problème de santé publique au Bénin;induisent un handicap important pour l’individu avec des répercussions sur ses activités quotidiennes.Motsclés : Bénin, douleurs neuropathiques, population générale


ID : 200276


TITLE : VASCULAR MALFORMATIONS AND INTRACEREBRAL HEMATOMA: CLINICAL,RADIOLOGICAL AND PROGNOSTIC FEATURES (ABOUT 40 PATIENTS)

Author : Brahem Zeineb [1] , Zaouali Jamel [1] , Bedoui Ines [1] , Riahi Anis [1] , Derbali Hajer [1] , Messelmani Meriem [1] , Mansour Malek [1] , Mrissa Ridha [1]

Affiliation : [1]Department of Neurology, Military Hospital of Tunis, Tunisia


ABSTRACT : INTRODUCTION: Vascular malformations (VM) represent 5% of etiologies ofintracerebral hematomas (ICH) with a higher rate in young people. We differentiate three types ofmalformations: aneurysms, arteriovenous malformations (AVM) and cavernous malformations (CM).METHODS: We analyzed patients presenting ICH revealing VM hospitalized during the period [2006 2016]. All of these patients had cerebral imaging. RESULTS: Forty patients were studied: 16 (40%)had AVM, 13 (32.5%) had CM and 11 (27.5%) had aneurysm. The mean age was 45 years. Clinicalmanifestations were dominated by headache followed by seizures and coma. The lobar seat was themost frequent than cerebellum. The largest hematoma was encountered with AVM while small onewith CM. A cerebral angiography led to diagnosis of VAS and aneurysm in 23 patients. AVM were themost likely source of death (73% of deaths). DISCUSSION: AMV are the leading causes of ICH inpatients <50 years old followed by aneurysms and CM. Clinical manifestations vary from headache toconvulsion and coma. The diagnosis of AMV and aneurysms is based on cerebral angiography,whereas CM is better visible in cerebral MRI. Hematoma sits preferentially in supratentorial andmanifests in 70% of cases by lobar ICH. Hemorrhages of great abundance are associated with AVMin contrast to CM. Thus, mortality is higher in case of AMV in accordance with our results.CONCLUSION: The occurrence of ICH in patients less than 50 years old systematically requires theinvestigation of VM by an MRI or cerebral angiography to be on time for surgery or arterialembolization.


ID : 200277


TITLE : SUIVI THéRAPEUTIQUE DES PERSONNES SOUFFRANT D’éPILEPSIE PAR LE DOSAGEPLASMATIQUE DES MéDICAMENTS ANTIéPILEPTIQUES AU CNHU HUBERT K. MAGA DECOTONOU

Author : ADJIEN K. Constant [1] , GNONLONFOUN Dieudonné [1] , AVODE Nadège [1] , HOUINATO Dismand [1]


TOPIC : Epilepsy

ABSTRACT : INTRODUCTION L’épilepsie est une affection neurologique chronique qui constitue depar sa prise en charge et son suivi médical un problème de santé publique. OBJECTIFS Etudier lesuivi thérapeutique des personnes souffrant d’épilepsie (PSE) par le dosage plasmatique desmédicaments antiépileptiques (MAE). METHODES Il s’agissait d’une étude transversale descriptive etanalytique qui s’était déroulée au Centre National Hospitalier et Universitaire Hubert K. Maga (CNHUHKM) de Cotonou du 1er Mars au 31 Décembre 2013 et portant sur les épileptiques traités par lephénobarbital, la carbamazépine ou l’acide valproïque en monothérapie ou en association et qui ontatteint l’état d’équilibre pharmacocinétique. Le dosage était effectué par la méthode CMIA (dosageimmunologique microparticulaire par chimiluminesce).Les données ont été analysées par le logicielEpi info. Résultats 70 PSE étaient recrutés dont 36 de sexe masculin et 34 de sexe féminin. Lephénobarbital en monothérapie est le MAE le plus employé dans une proportion de 55,7%. Laconcentration thérapeutique était observée chez 30% des sujets pour le phénobarbital, 48% pour lacarbamazépine et 45 % pour l’acide valproïque. 20% des PSE ont une mauvaise observance dutraitement et la raison évoquée était les effets indésirables des médicaments. Discussion Lephénobarbital est le plus employé dans une proportion de 55,7%. KISSANI et al. au Maroc ont eu desrésultats similaires. Le Phénobarbital est le MAE le plus disponible et le plus accessible auxpopulations des pays en développement. Conclusion Ce travail a permis de contrôler l’observancethérapeutique des patients. Mots clés : épilepsie, MAE, dosage plasmatique


ID : 200280


TITLE : IMMUNE STUDY OF ALPHA SYNUCLEIN ON UPPER ENTERIC SYSTEM BY ENDOSCOPYON TUNISIAN PARKINSON POPULATION

Author : Emna Kacem, Salwa Mrabet, Mariem Kchaou, Slim Chebbi, Hela Jamoussi, Saloua Fray,Nadia Ben Ali, Mohamed Fradj [1]

Affiliation : [1]hôpital charles Nicolle Tunis tunisie


ABSTRACT : Parkinson’s disease (PD) is a neurodegenerative disorder diagnosed with the clinicalhallmarks of motor parkinsonism. Nonmotor signs (NMS) including autonomic dysfunction mayprecede the first signs of parkinsonism and are due to dopaminergic neuronal loss on enteric nervoussystem (ENS). Alpha synuclein deposition follows neurodegeneration. The aim of our study is toinvestigate the relationship between alpha synuclein deposition at the SNE and PD and clinicalhistological correlations arising. We find that gastrointestinal tract might be a portal of pathogen entryin PD. We have shown that the UDT biopsies of ENS can be used as biomarker of PD. We conducteda retrospective study in Neurology Department of Charles Nicolle hospital of Tunis during 2 years(20132015) including PD patients. Digestive endoscopy with biopsies of upper digestive tract (UDT)and immunohistochemistry study were performed. Thirty patients were included.Immunohistochemistry confirmed the diagnosis of PD in 100% patients through the presence of alphasynuclein deposits in ENS. Lesion load in alpha synuclein was significantly correlated with the severityof NMS especially gastrointestinal and the severity of motor disability. A rostrocaudal gradient of theprogression of ENS lesions was found it s the first study of upper gastrointestinal biopsies with highsensitivity and a positive correlation with neuropathological processes and disease severity.


ID : 200281


TITLE : CEREBRAL AUTOSOMAL DOMINANT ARTERIOPATHY WITH SUBCORTICAL INFARCTSAND LEUKOENCEPHALOPATHY

Author : Brahem Zeineb [1] , Zaouali Jamel [1] , Bedoui Ines [1] , Riahi Anis [1] , Derbali Hajer [1] , Messelmani Meriem [1] , Mansour Malek [1] , Mrissa Ridha [1]



ABSTRACT : INTRODUCTION: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarctsand Leukoencephalopathy (CADASIL) is a hereditary cerebrovascular disease occurring in middleage and characterized by recurrent subcortical ischemic strokes and cognitive impairment.Intracerebral hematomas (ICH) are rare manifestations. CASE REPORT: Two men aged respectively47 and 41 years old had a family history of migraine, hemorrhagic and ischemic vascular accidentsand cognitive impairment were hospitalized. One patient was hypertensive and the other hadmigraine. They had a heaviness of hemibody in one patient and brutal dysarthria in the second case.CT scan showed ICH in both cases: in right external capsular in one case and left thalamic in theother with presence of microbleeds and diffuse vascular leukopathy on cerebral MRI. DISCUSSION:CADASIL is caused by mutations in NOTCH3 gene expressed by vascular smooth muscle cells. Itmanifests around the age of 50 and is characterized by the appearance of recurrent subcorticalischemic cerebrovascular strokes, progressive dementia and migraine with aura. The occurrence ofhemorrhagic accidents is much rarer and unusual. According to the literature there are only 21 casesreported with adequate clinical and genetic data. These patients had an average age of 56 years witha more frequent localization of hematomas in the basal ganglia. Cerebral MRI typically showssymmetrical hypersignals of the white matter, subcortical infarcts, microhaemorrhages and rarelyhematomas. CONCLUSION: In front of ICH in a young adult with a family and personal history withmigraine, stroke and cognitive impairment, CADASIL may be mentioned, but confirmation still genetic.


ID : 200289


TITLE : A WEST NILE VIRUS MENINGOENCEPHALOMYELORADICULITIS IN A NONENDEMICREGION IN TUNISIA : A CASE REPORT

Author : Ben Amou Boutheina [1] , Sahli Hana [2] , Amri Raja [3] , Ben Ahmed Imen [4] , SidhomYoussef [5] , Gargouri Amina [6] , Gouider Riadh [7]

Affiliation : [1]Hospitaluniversity assistant in Neurology, Internal Medicine Department, MohamedTahar Maamouri Hospital, Nabeul, Tunisia, [2]Hospitaluniversity assistant in rhumatology, InternalMedicine Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia, [3]Hospitaluniversityassistant in internal medicine, Internal Medicine Department, Mohamed Tahar Maamouri Hospital,Nabeul, Tunisia, [4]Nutrition and diabetology specilist, Internal Medicine Department, MohamedTahar Maamouri Hospital, Nabeul, Tunisia, [5]Hospitaluniversity assistant in Neurology, NeurologyDepartment, Razi Hospital, Manouba, Tunisia, [6]Associate Professor in Neurology, NeurologyDepartment, Razi Hospital, Manouba, Tunisia, [7]Professor in Neurology, Neurology Department,Razi Hospital, Manouba, Tunisia


ABSTRACT : West Nile virus (WNV) is a mosquitoborne RNA flavi virus. The majority of human WNVinfections are asymptomatic in 80% of cases. Severe forms are associated with neurologicalsyndromes. We report the case of a 26 year old man with no significant past medical history nativefrom the Cap Bon in north of Tunisia. Two weeks before he developed a facial paralysis with speechtrouble. Then, he developed fever, headache, nausea, vomiting and photophobia. After two days, hedescribed weakness of his left leg and urinary disorder. Twenty days after, he developed anerythematous skin rash in the trunk and limbs. Clinical examination found a normal mental status, afever at 38, dysarthria, a flaccid monoparesis of the left leg with absence of deep tendon reflex, rightcentral facial paralysis. Cerebral scan and MRI were normal. Cerebrospinal fluid analysis showed alymphocytic meningitis. NCS showed a left root syndrome in L3L4 and L5S1. Serum tested waspositive for WNV. The diagnosis was a WNV meningoencéphalomyeloradiculitis. Neuromuscularmanifestations are now recognized as a prominent feature in patients with WNV neuroinvasivedisease. Our presentation highlights that WNV infection can present, in addition to the classical formof meningoencephalitis, an extensive form with a flaccid paralysis with urinary disorder as amanifestation of myeloradiculitis despite that Tunisia is not an endemic country for WNV infection,particularly the Cap Bon.


ID : 200301


TITLE : PARANEOPLASTIC AMYOTROPHIC LATERAL SCLEROSIS: MYTH OR REALITY?

Author : Mnif Hela [1] , Naija Salma [1] , Arous Amal [1] , Hessine Anis [1] , Ben amor Sana [1] , Benammou Soufiene [1]

Affiliation : [1]department of neurology, Sahloul hospital, Sousse, Tunisia


ABSTRACT : Introduction: Paraneoplastic neurological syndromes are rare. They affect peripheraland central nervous system. paraneoplastic motor neuron disease is still poorly documented.Observation We report two cases (one patient was 75 years old the other was 55 years old) ofparaneoplastic amyotrophic lateral sclerosis. They presented with subacute motor deficit in all 4 limbsover a period of 2 months. Examination showed pyramidal and lower motor neuron signs. The firstpatient also had pseudobulbar palsy. As patients appeared cachexic at presentation, we suggestedparaneoplastic origin. Indeed, we diagnosed smallcell lung cancer in the first patient and acholangiocarcinoma in the second. Discussion: Most examples of Amyotrophic lateral sclerosis andneoplasm do not constitute classically established Paraneoplastic neurological syndromes. Rareinstances of elevated onconeuronal antibody titres or typical neoplasm, implies that, albeit rare, theParaneoplastic neurological syndromes is one of a multitude of causes of ALS. The diagnosis of acancer within 2 years of evolution confirms paraneoplastic syndrome.


ID : 200317


TITLE : UNUSUAL PRESENTATION OF TUBERCULOUS ARACHNOIDITIS IN CHILDREN

Author : Moalla Khadija Sonda [1] , Ayedi Ines [1] , Ellouze Emna [1] , Kamoun Fatma [1] , TrikiCharfi Chahnez [1]

Affiliation : [1]Hedi Chaker Hospital, Child Neurology Departement, Sfax, Tunisia


ABSTRACT : Introduction: The incidence of tuberculosis (TB) is increasing in both developing anddeveloped countries, and children, in particular, represent a highrisk group for acquiring the disease.TB of the central nervous system (CNS) is the most severe, lifethreatening form of TB in infants andchildren. Approximately 10% of all patients with TB have CNS involvement. We report a pediatric casewith unusual presentation of TB arachnoiditis. Case report: Three years old male with no TB contactpresented with acute weakness of the lower limbs. Associated symptoms included a loss of appetite,fever, and lethargy. Physical examination disclosed flaccid and areflexic paraplegia associated tomeningism. Sensory and motor nerve conduction velocities were normal. Lumbar puncture yieldedraised protein levels in the cerebrospinal fluid (CSF) (2.46 g/L) and raised cell count levels (150cells/mm3) with lymphocytes predominating. A magnetic resonance imaging (MRI) of the spineshowed leptomeningeal disease in the spinal cord (shaggy enhancement of the arachnoid mater,nerve roots, and conus medullaris), consisting of arachnoiditis. Complete blood count, urine analysisand other laboratory tests including viral serology tests were within normal limits. PCR of CSF did notfind viral or bacterial genome. He had a positive interferongamma release assay (QuantiFERON®).We suspected TB. No other locations of the disease were found. He was treated by antituberculoustreatment (ATT) and steroids with good outcome. Conclusion: TB arachnoiditis is sometimes difficultto diagnose and requires the practice of specific tests. Favorable outcomes after a quickadministration of ATT comfort the diagnosis. It should be initiated as soon as possible to avoidirreversible motor sequelae.


ID : 200318


TITLE : HOSPITALBASED STUDY OF THE COST OF STROKE AND ITS DETERMINANTS INCAMEROON

Author : KuateTegueu Callixte [1] , KenmogneKontchou MarieAchille [2] , Doumbe Jacques [3] , Noubissi DadaGustave [4] , MapoureNjankouo Yacouba [5] , Djientcheu VincentDePaul [6]

Affiliation : [1]Neurology Department, Douala Laquintinie Hospital, Douala, Cameroon and Faculty ofMedicine and Biomedical Sciences, The University of Yaounde I, Yaoundé, Cameroon, [2]InstitutSupérieur des Sciences de la Santé, Université des Montagnes, Bangangté, Cameroun, [3]Facultéde Médecine et des Sciences Pharmaceutiques, Université de Douala, Cameroun and NeurologyDepartment, Douala Laquintinie Hospital, Douala, Cameroon, [4]Neurology Department, DoualaLaquintinie Hospital, Douala, Cameroon, [5]Faculté de Médecine et des Sciences Pharmaceutiques,Université de Douala, Cameroun, [6]Faculty of Medicine and Biomedical Sciences, University ofYaounde I, Yaoundé, Cameroon


ABSTRACT : Introduction : In subSaharan Africa, the cost of stroke management is borne bypatients and their families. Few studies exist on the cost of stroke in Cameroon. Objective: Todetermine the direct cost of inpatient stroke management in the two reference hospitals in the city ofDouala. Methodology : Descriptive, crosssectional study over a period of six months, from 1 March to31 August 2013, at the General Hospital of Douala (HGD) and the Laquintinie Hospital of Douala(HLD). Were patients hospitalized for stroke, confirmed by a cerebral scan. Data on cost of care werecollected. The cost analysis was done in CFA francs, the currency used in Cameroon (1 Euro = 656FCFA). Results : We included 208 patients including 49.5% of women, mean age 60 ± 12.8 years.The average cost of stroke care at the HGD was estimated at CFAF 951 855 (1450 €) per patient,and 435 672 FCFA (664 €) to the HLD. The factors determining the cost of stroke management were:type of hospital, type of stroke, duration of hospitalization. Discussion : The cost of hospital care ishigher in hemorrhage than ischemia. Numerous studies have already been done on the cost of strokemanagement around the world. In Africa, health financing is provided by patients, with littleintervention by the State. Conclusion : The average cost of hospital management of stroke inCameroon is very high, representing 17 times the minimum wage. It is twice as high for hemorrhage.


ID : 200319


TITLE : L’APPORT DE L’éLéCTRONEUROMYOGRAPHIE DANS LA PATHOLOGIE TRAUMATIQUE :EXPéRIENCE DU SERVICE DE NEUROPHYSIOLOGIE DU CHU MOHAMED VI DE MARRAKECH

Author : Meriem El Mellakh, Najib Kissani [1] , Mohamed Chrra [1]

Affiliation : [1]Department of Neurology, CHU Med VI, Marrakech, Morocco


ABSTRACT : INTRODUCTION : Les buts de l’ENMG, dans la pathologie traumatique sontd’objectiver l’atteinte du SNP, de la quantifier, d’établir un pronostic et de prévoir la récupération bienavant la clinique. Le but de ce travail : est d’étudier les différentes indications, et le profil ENMG dansla pathologie traumatique au service de neurophysiologie de Marrakech sur une période de deuxans. PATIENTS ET METHODES : Etude rétrospective de 50 dossiers de patients adressés au servicede neurophysiologie de Marrakech entre les années 20142015 RESULTATS : 72% des patients sontde sexe masculin, avec une atteinte du plexus brachial dans 65% suivi d’une atteinte isolée du nerfradial dans 15% des cas, du nerf ulnaire dans 10% des cas,5% du nerf médian, 4% du nerf facialaprès fracture du rocher, et dans 1% des cas un atteinte du nerf musculo cutané et du nerf sciatiquepoplité externe. Le mécanisme du traumatisme est dominé par les accidents de la voie publique dans75% des cas suivi de chutes et de plaies par objets tranchants et enfin par morsure d’animaux.Discussion : l’atteinte du plexus brachial, qui est majoritaire dans notre série, a une réputation degravité, justifiée par la difficulté de son traitement et la fréquence de ses séquelles. Conclusion : Dansles atteintes post traumatiques des nerfs périphériques, L’ENMG reste le seul examen capabled’établir un pronostic et de prévoir la récupération bien avant la clinique.


ID : 200322


TITLE : OPTICAL COHERENCE TOMOGRAPHY AS AN ADJUNCTIVE TOOL FOR DIAGNOSINGPAPILLEDEMA

Author : BEN SALEM MARIEM [1] , CHEBBI AMEL [1] , ROUATBI AICHA [1] , KORBI MOHAMED [1], MASMOUDI AMINE [1] , ZBIBA WALID [1] , BOUGUILA HEDI [1]

Affiliation : [1]ophtalmology Departement"C" Hedi Raies national institute of ophtalmology TunisTunisia

TOPIC : Other

ABSTRACT : Introduction Papilledema is an optic disc swelling, caused by increased intracranialpressure. Early diagnosis of papilledema is required for preventing visual loss and even death.Distinguishing between this entity and pseudopapilledema is often challenging. A new technologies inthe evaluation of optic nerve based on measurement of retinal nerve fiber layer thichness (RNFL) byOptical coherence tomography (OCT) can provide relevant data for early and accurate diagnosis ofpapilledema. The aim of this study was to analyze the difference in the RNFL thickness in patientswith true papilledema from pseudopapilledema and normal population. Methods Database ofSpectral OCT imaging of patients with papilledema (21 cases), pseudopapiledema (18 cases), andnormal controls (32 eyes) was retrospectively analyzed. RNFL in the four quadrants in peripapillaryareas and the mean RNFL thickness were compared in all three groups. Results The median RNFLthickness was 183 μm), 120 µm and 89 μm in papilledema, pseudopapilledema, and controls,respectively. Papilledema group had thicker RNFL in all quadrants compared to other groups(p=0,001). Head drusens were directly visualized as high reflective clumps in the subretinal space inall pseudopapilledema cases. Conclusion OCT can be included as a routine noninvasive quantitativetool for detection of early papilledema. It can differentiate between papilledema, pseudopapilledema,and a normal disc.


ID : 200325


TITLE : OPTIC NEUROPATHY COMPLICATING OPTIC DISC DRUSEN

Author : CHEBBI AMEL [1] , BEN SALEM MARIEM [1] , ROUATBI AICHA [1] , KORBI MOHAMED [1], MASMOUDI AMINE [1] , ZBIBA WALID [1] , BOUGUILA HEDI [1]


TOPIC : Other

ABSTRACT : Introduction: Optic disc drusen are congenital anomalies of the optical diskcharacterized by calcified nodules with irregular edges. Drusen are most often discovered incidentallyduring a routine eye examination, but in rare cases can achieve real optic neuropathy. Case report: A17yearold patient presented with a history of sudden painless bilateral visual loss that had occurredfew days prior. On examination, bestcorrected visual acuity was inferior to 1/10 in the right eye and3/10 in the left eye, anterior segment examination was unremarkable and intraocular pressure wasnormal bilaterally. Eye fundus in both eyes showed hyperemic and protruding optic disc with blurryedges and preserved excavation. Goldmann perimetry revealed a constricted visual field in the righteye and scotoma in the left eye. Fundus fluorescein angiography showed late inhomogeneous polylobed disc hyperfluorescence. MRI was normal. Laboratory studies were normal. A diagnosis of opticneuropathy complicating optic disc drusen was made. The patient received 3 bolus of Solumedrolwith relay by oral corticosteroids with good evolution. Conclusion: Optic disc drusen are sometimesconsidered as a simple feature of the fundus. Acute anterior ischemic optic neuropathy (NAAIO) is arare but serious complication.


ID : 200327


TITLE : OPTICAL COHERENCE TOMOGRAPHY IN OPTIC NEURITIS AND MULTIPLE SCLEROSIS

Author : BEN SALEM MARIEM [1] , CHEBBI AMEL [1] , ROUATBI AICHA [1] , KORBI MOHAMED [1], MASMOUDI AMINE [1] , ZBIBA WALID [1] , BOUGUILA HEDI [1]



ABSTRACT : INTRODUCTION Optical coherence tomography (OCT) is a noninvasive imaging,which allows measureming retinal nerve fiber layer (RNFL) thickness. Given its high degree ofreliability, sensitivity and ease of use, OCT is an ideal method for assessing pathologic changes in theanterior visual pathway due to optic neuritis (ON) and multiple sclerosis (MS). The aim of this studywas to assess the role of measuring RNFL by OCT in the diagnosis and the prognosis of optic neuritisand multiple sclerosis. METHODS We compared the thickness of the peripapillary RNFLin 18 patientswith MS against the thickness of healthy patients (No optic neuropathy). Diagnosis of MS was basedon the MacDonald criteria. The cohort of MS was divided into two groups based on their clinicalcourse (with or without optic neuritis antecedents). visual acuity and Visual field were also notedRESULTS There were highly significant reductions (p < 0.001) of retinal nerve fiber layer thickness inaffected patients (with or without optic neuritis antecedents) compared with control eyes. Visualacuity, visual field and color vision were globally less altered than OCT. There were no significantrelationships among RNFL thickness and visual acuity, visual field, or color vision CONCLUSION Themeasurement of RNFL thickness by OCT is being increasingly used to detect and monitor axonaldamage of the optic nerve. This reproducible and non invasive test provides relevant data fordiagnosis, followup, and prognosis of optic neuritis and multiple sclerosis.


ID : 200328


TITLE : DETERMINANTS OF DIABETIC POLYNEUROPATHY OF THE ELDERLY IN SUBSAHARANAFRICA.

Author : KuateTegueu Callixte [1] , Doumbe Jacques [2] , NgankouTchankeu Stève [3] , NoubissiDadaGustave [4] , Kamdem Aimé [5] , NambouLontsi Hervé [5]

Affiliation : [1]Neurology Department, Douala Laquintinie Hospital, Douala, Cameroon and Faculty ofMedicine and Biomedical Sciences, The University of Yaounde I, Yaoundé, Cameroon, [2]Faculté deMédecine et des Sciences Pharmaceutiques, Université de Douala, Douala, Cameroon et Service deNeurologie, Hôpital Laquintinie de Douala, [3]Institut Supérieur des Sciences de la Santé, Universitédes Montagnes, Bangangté, Cameroun, [4]Service de Neurologie, Hôpital Laquintinie de Douala,Douala, Cameroun, [5]Service de Neurologie, Hôpital Laquintinie de Douala


ABSTRACT : Background: Diabetic polyneuropathy is associated with significant physical disabilityamong older adults. We assessed the hospitalbased prevalence and predictors of diabeticpolyneuropathy in elderly patients in an urban setting in Cameroon. Methods: A crosssectionalsurvey was conducted at the Douala Laquintinie Hospital, which is the main reference hospital in theeconomic Capital of Cameroon. Participants were recruited over a 5months period and included allpatients with type 2 diabetes who reported to the hospital regardless of the reason. Polyneuropathywas defined as diabetic in a patient with a Diabetic Neuropathy Examination score > 3/16. Results: Atotal of 159 elderly patients with diabetes were seen during the recruitment period, of whom 106(66.7%) were women. The mean age was 68.3 ± 6.5 years and the median duration of diabetes was108 months. For all patients submitted to Diabetic Neuropathy Examination score, clinical signs ofpolyneuropathy were present in 31.4% and among them, it was symptomatic in 78%. Predictors ofpolyneuropathy in these elderly were glycated hemoglobin (p= 0.049), infection with HIV (p=0.031)and presence of albuminuria (p= 0.0001). Conclusion: About a third of elderly patients reporting tohospital in our setting has prevalent diabetes related polyneuropathy. This emphasizes theimportance of early detection through routine screening and regular followup examinations inreducing the burden of disability among elderly diabetics and improve their quality of life.


ID : 200330


TITLE : EPIDEMIOLOGICAL AND CLINICAL PROFILES OF MULTIPLE SCLEROSIS: A STUDY OF AMOROCCAN COHORT

Author : GOUITI HIND [1] , CAMARA NENE AISSATA [1] , Azanmasso Herman [1] , Mouni FatimaZohra [1] , EL OTMANI hicham [1] , EL MOUTAWAKIL bouchra [1] , RAFAI Mohammed Abdoh [1] , ilham SLASSI [1]

Affiliation : [1]Department of neurologyneurophysiology Ibn Rochd University Health Centre


ABSTRACT : Introduction: Multiple sclerosis (MS) is a pathology presumed related to the interactionof a predisposing genetic factor with environmental factors. Goal: to describe the epidemiological andclinical characteristics of MS patients in a Moroccan cohort. Patients and Methods: A prospective,crosssectional, descriptive, analytical, monocentric study, over 20 months, of patients followed forMS at the university hospital IBN ROCHD of Casablanca. Data collected directly from patients plus aretrospective analysis of clinical records. Results: Recruited patients: 175, with a femalepredominance (69%). Mean age at onset: 28 years. Average EDSS: 3. Obesity: 20%. Overweight:48%. Overweight during adolescence: 52%. Low daily intake of vitamin D: 68%. Smoking: 15%.Passive maternal smoking during pregnancy: 31%. Consanguinity of 1st degree: 32%. MS in thefamily: 13%. Conclusion: According to our study, low vitamin D intake and overweight duringadolescence are the most prevalent risk factors in our population, which is consistent with data fromthe literature. On the other hand smoking remains low in our population contrasting with the literaturedata. These factors are implicated not only in MS but also in other pathologies common in our countryso prevention aimed at them is justified.


ID : 200334


TITLE : FACTEURS PRéDICTIFS DE L’éPILEPSIE VASCULAIRE : à PROPOS DE 12OBSERVATIONS

Author : Hidouri Beyrem [1] , Machraoui Rafik [1] , Younes Samia [1] , SFAR Mohamed Habib [1] , AISSI Mouna [2] , FRIH Mahbouba [2]

Affiliation : [1]EPS Mahdia, service de médecine interne et endocrinologie, Mahdia 5100, [2]servicede neurologie, EPS Fattouma Bourguiba Monastir, TUNISIE

TOPIC : Epilepsy

ABSTRACT : Introduction :Les lésions vasculaires cérébrales exposent à un risque accru de criseépileptiques et d’épilepsie. Elles sont en cause dans au moins un tiers des épilepsies âpres 60 ans.Patients, méthodes et résultats : Etude rétrospective a visée descriptive et analytique, déroulée du1er janvier 2016 au 31 décembre 2016 dans le département de neurologie. Le diagnostic de l’EV aété posé sur la base de la répétition de crises d’épilepsie au moins 7 jours après la constitution del’AVC, en relation avec celuici avec ou sans graphoéléments a` l’EEG. Pendant la période d’étude,138 patients avaient été pris en charge dont 12 cas d’EV, soit une fréquence hospitalière de 8.6 %.L’âge moyen était de 62 ans. Les crises étaient partielles simples dans 82 % des cas. Les anomaliesles plus fréquentes sont des ralentissements focaux. La topographie corticale de l’infarctus est un desfacteurs prédictifs de crise précoces le plus fréquemment identifié. Discussion : A travers notre étudenous concluons que la fréquence de l’EV est assez faible comme dans la plupart des autres études.Les aspects cliniques de ces crises au cours des AVC sont différemment apprécies. Les graphoéléments retrouvés a` l’EEG ne sont pas spécifiques. Conclusion : Il est désormais impérieuxd’évoquer le diagnostic d’épilepsie vasculaire devant tout patient ayant un AVC et qui présente desépisodes critiques d’allure convulsive.


ID : 200341


TITLE : PHRENIC NERVE CONDUCTION STUDIES IN SIX PATIENTS WITH AMYOTROPHICLATERAL SCLEROSIS AND REVIEW OF THE LITERATURE

Author : Boubacar MAIGA [1] , Leila ERRGUIG [1] , Leila Tamaoui [1] , Fatimata hassane DJIBO [1]

Affiliation : [1]Service de Neurophysiologie clinique, Hôpital des spécialités, CHU Ibn Sina, Rabat


ABSTRACT : Introduction: Respiratory failure is a serious complication of amyotrophic lateralsclerosis (ALS). It appears either late or early in the course of the disease. Objective: To study thenerve conduction of the phrenic nerve in 6 ALS patients. Methods: Six patients with ALS wereevaluated clinically and the phrenic nerve was stimulated at the posterior margin of thesternocleidomastoid muscle above the clavicle, the recording electrode placed over the xiphoidprocess, the reference on the rib margin. The latencies and amplitudes were compared with a controlgroup of five healthy controls, free from any neuromuscular pathology. Results: Our patients wereaged 58 to 80 years old. respiratory failure was inaugural in one patient had and early in the courseof the disease in two others. Patients with respiratory symptoms showed substantial prolongation oflatencies and sharp reduction of the amplitudes. Discussion: ALS, neurodegenerative disease causesprogressive weakness and muscle atrophy resulting in death. In cases of diaphragmatic paralysis withrespiratory failure, noninvasive ventilation treatment improves quality of life. In the course of ALS, noconsensus exists on the best exploration of lung function. The nerve conduction studies of thephrenic nerve are an objective measure of the state of innervation of the diaphragm. The responsesof phrenic nerve conduction directly correlate with symptoms, signs and laboratory measurements ofrespiratory failure in ALS. Conclusion: The phrenic nerve conduction studies is a means of objectiveassessment of diaphragm involvement in patients with ALS who are subject to diaphragmaticparalysis. Keywords: ALS, Electroneurography, Phrenic nerve


ID : 200342


TITLE : EPIDEMIOLOGICAL AND CLINICAL ASPECTS OF PARKINSON 'S DISEASE: FIRSTNIGERIEN COHORT.

Author : Hamid ASSADECK [1] , Fatimata HASSANE DJIBO [1] , Moussa TOUDOU DAOUDA [1] , Soumaila BOUBACAR [1] , Djibrilla BENADJI [1] , Konate MAHADI [1] , Djibo DOUMA MAIGA [1] , Eric OMAR ADEHOSSI [1]

Affiliation : [1]Service de médecine et spécialités médicales, Hôpital National de Niamey, Niger


ABSTRACT : Introduction – Parkinson's disease is characterized clinically by the classic triadassociating akinesia, rigidity and rest tremor. The aims of this study are to describe theepidemiological and clinical aspects of the first cases of Parkinson's disease in Niamey (Niger).Methods – Our study is prospective, conducted in neurological consultation at the Niamey NationalHospital from February 2009 to July 2013. The diagnosis of Parkinson's disease was based on thediagnostic criteria of the UK Parkinson's Disease Society Brain Bank. Results – During the period ofour study, 1695 patients were received in neurological consultation among which 25 patients weresuffering of Parkinson's disease (1.47%). The median age of the onset of symptoms was 58 years(range: 42 and 74 years). The sex ratio was 1.5 in favor of men. According to the classification ofHoehn and Yahr on the scalable stades of Parkinson's disease, 8 patients (32%) were in stage I, 16patients (64%) in stage II, and one patient (4%) in stage III at the time of diagnosis. Nonmotormanifestations were sleep disorders in 9 patients (36%), anxiodepressive disorders in 6 patients(24%), visual hallucinations in 4 patients (16%), dysautonomic disorders in 8 patients (32% ). Theother complications were freezing in 8 patients (32%), postural disorders in 3 patients (12%).Discussion and conclusion – The ignorance of Parkinson's disease in our societies could explain thelow frequency of Parkinson's disease in Niger and the late diagnosis of the disease. Keywords :Parkinson’s disease, prevalence, Niger.


ID : 200343


TITLE : MYéLORADICULITE à STREPTOCOQUE DU GROUPE B SUR TERRAIN DE RéTROVIROSEVIH 1

Author : ALASSANE MAMADOU DIOP [1]

Affiliation : [1]DOCTOR NEUROLOGY FANN HOSPITAL DAKAR SENEGAL


ABSTRACT : Méningomyéloradiculite à streptocoque sur terrain de rétrovirose à VIH 1I.INTRODUCTION La preuve biologique d’une atteinte infectieuse dans lesméningomyéloradiculopathies est difficile à confirmer car il s’agit parfois d’une atteinte postinfectieuse. II. OBSERVATION Une patiente de 13 ans, suivie pour une infection à VIH 1 depuis 6ans. Son traitement antirétroviral initial était composé de AZT 3TC EFV avec échec thérapeutique parmauvaise observance du traitement. Elle présentait à l’examen un syndrome méningé, un syndromeinfectieux et un syndrome d’interruption médullaire. La ponction lombaire ramenait un liquide troubleavec une pleiocytose à 740 éléments avec 100% de polynucléaires altérés, une hyperproteinorachieà 5,66g/l et une glycorachie à 0,60/l. La recherche d’antigène soluble par le test au latex était positiveau streptocoque B hémolytique du groupe B. La culture bactériologique était négative. On notait à laNFS une anémie hypochrome microcytaire avec des leucocytes à 7240/Ul et une CRP négative. Letaux de CD4 était à 307/mm3 et la charge virale à 843787 copies/ml. L’IRM médullaire avait mis enévidence des hypersignux T2 étendus plus marqués en T12. L’electroneuromyogramme mettait enévidence une atteinte axonomyélinique des deux membres inférieurs. L’évolution était bonne sousceftriaxone 3g/jour, avec une apyrexie stable après 72 heures d’antibiothérapie. On notait égalementà mois une bonne récupération sur le plan sensitif mais une persistance du déficit moteur avec scorede Rankin modifié à 5. Conclusion Les atteintes du système nerveux au cours de l’infection à VIHsont très fréquentes.


ID : 200345


TITLE : THE PATTERN OF INVOLVEMENT OF THE LOWER LIMB NERVES IN DIABETICNEUROPATHY AMONG CHILDREN WITH TYPE I DIABETES MELLITUS

Author : Nimat Abuelwafaa [1] , Hana Ahmed [1] , Ilham Omer [2] , Mohamed Abdullah [3] , Ammar Ahmed [4] , Afraa Musa [5]

Affiliation : [1]Teaching Assistant/ Department of physiology/ Faculty of Medicine/ University ofKhartoum/ Sudan , [2]Associate Professor of Paediatrics/ Faculty of Medicine/ University ofKhartoum/ Sudan , [3]Professor of Paediatrics/ Faculty of Medicine/ University of Khartoum/ Sudan , [4]Professor of Physiology/ Senior consultant Neurologist/ Clinical Neurophysiologist/ Faculty ofMedicine/ University of Khartoum/ Sudan , [5]Assistant Professor/ Department of physiology/ Facultyof Medicine/ University of Khartoum/ Sudan


ABSTRACT : Background:Diabetic peripheral neuropathy (DPN) involves both sensory and motornerves; from pathological point of view it can cause demyelinating neuropathy (evident by increase inlatency and decrease in conductionvelocity [CV]) as well as axonal degeneration neuropathy (evidentby decrease in amplitude) of compound action potential. However there is controversy on which is themost affected nerve and nerve conduction study (NCS) parameter in DPN. Objective: To describe thepattern of lower limb nerves involvement based on parameters of nerve conduction study.Design/Methods:Bilateral NCS of the sensory & motor lower limb nerves [sural, commonperoneal,posteriortibial) was performed. This study recruited 50 type 1diabetic children with different diseaseduration (4.92±3.84years) attending the referred clinic in Sudan Childhood Diabetes Center [theirmean age (15.00±2.19years), (42% male & 58% female) and 25 matched healthy controls [(theirmean age(13.88±2.46years), (38.46% male & 61.54% female)]. Interpretation of the results based onour own control reference values which were similar to the worldwide literature. Results: Out of 50diabetic patients, 44 (88%) were found to have electrophysiological evidence of peripheralneuropathy. Out of the 44 diabeticneuropathy patients, (68.2%) had motor, (31.8%) hadsensorimotor while none of them (0%) had puresensory involvement. Pathological involvementrevealed demyelinating neuropathy (61.4%), axonal degeneration (6.8%) and mixedtype neuropathy(31.8%). The most affected nerve was the commonperoneal followed by posteriortibial & least thesuralnerve. The most sensitive parameter was commonperoneal CV. Conclusions:Motorinvolvement precedes sensory involvement. The most frequent pattern of pathological involvementwas demyelination & the commonperoneal was the most vulnerable nerve.


ID : 200349


TITLE : ELECTRODIAGNOSTIC EVALUATION OF LUMBOSACRAL RADICULOPATHY CAUSED BYLUMBAR INTERVERTEBRAL DISC HERNIATION

Author : Safa Yousif [1] , Afraa Musa [2] , Ahmed Abdelhai [3] , Ammar Ahmed [4]

Affiliation : [1]Teaching Assistant/ Department of physiology/ Faculty of Medicine/ University ofKhartoum/ Sudan , [2]Assistant Professor of Physiology/ Faculty of Medicine/ University of Khartoum/Sudan , [3]Assistant Professor of Orthopedics and Spinal Surgery/ Faculty of Medicine/ University ofKhartoum/ Sudan , [4]Professor of Physiology/Senior consultant Neurologist/ ClinicalNeurophysiologist/ Faculty of Medicine/ University of Khartoum/ Sudan


ABSTRACT : Background: Nerve conduction studies (NCS) are noninvasive electrodiagnostic testsused to evaluate peripheral nerves functions in patients with neuromuscular complaints. There is acontrasting evidence with regard to it is use in assessment of patients with lumbosacral radiculopathy.Objectives: This study was conducted to evaluate NCS abnormalities in patients with lumbosacralradiculopathy. Methods: This crosssectional analytic study was conducted at the physiologydepartment in Faculty of Medicine of Khartoum University. 27 patients with lumbosacral radiculopathycaused by L4/L5 or L5/S1 intervertebral discprolapse confirmed by MRI were recruited in the study.In addition, one or more of the following required for inclusion in the study: dermatomal distribution ofsymptoms appropriate with the MRI level, weakness on clinical examination, abnormal ankle jerk,diminished sensation and positive straight leg raise test. 25 healthy subjects served as control.Bilateral motor NCS, bilateral Fwave for both Common peroneal (CP) & Tibial nerves and Hreflex ofthe soleus muscle had been performed. Results: On comparing patient to control, no significantdifference was found in the motor NCS parameters (latency, amplitude and conduction velocity).There was significant prolongation in Hreflex latency of both symptomatic and asymptomatic sidescompared to control (p˂ 0.05). Fwave latencies (Fmin, Fmax and Fmean) of the Tibial nerve weresignificantly prolonged (p˂ 0.05) compared to control whereas those of commonperoneal revealedno statistically significant difference between patients and controls (p > 0.05). Conclusion: ProlongedHreflex latency was the most frequent encountered abnormality in our study followed by Fwavelatencies of the Tibial nerve.


ID : 200350


TITLE : A COMPARATIVE STUDY OF MOTOR NERVE CONDUCTION VELOCITY BETWEEN RIGHTHANDED AND LEFT HANDED SUBJECTS

Author : Duaa Ahmed [1] , Sarah Mousa [1] , Ammar Ahmed [2] , Afraa Musa [3]

Affiliation : [1]Master student/ Department of Physiology/ Faculty of Medicine/ University ofKhartoum/ Sudan , [2]Professor of physiology/ Senior Consulltant Neurologist/ ClinicalNeurophysiologist/ Faculty of Medicine/ University of Khartoum/ Sudan , [3]Assistant Professor ofPhysiology/ Faculty of Medicine/ University of Khartoum/ Sudan


ABSTRACT : Background & objectives:Motor Nerve conduction study is one of theelectophysiological tests performed to evaluate electrical conduction of motor nerves. Many studiesinvolved nerve conduction velocity of peripheral nerves, but only few addressed this issue in relationto handedness with lots of controversies in their results. This Study was conducted to compare motornerve conduction velocity between righthanded and lefthanded subjects in large sample size.Methods:The study was carried as analytical crosssectional study at the department of physiology,Faculty of Medicine, University of Khartoum and involved 120 healthy students from the medicalcampus, of whom 60 were righthanded and 60 were lefthanded. Nerve conduction studies wereperformed using MedelecSynergy machine. Two peripheral motor nerves of the upper limb (Median& Ulnar nerves) were investigated in each subject of the two groups bilaterally. Results:The studyrevealed no significant difference in motor nerve conduction velocities of the investigated motornerves (rightmedian, leftMedian, rightulnar & leftulnar nerves) between the righthanded and thelefthanded groups (P value > 0.05). Also when testing each group separately, no significantdifference was found in motor nerve conduction velocities of the motor nerves (median, ulnar)between the right and left sides of the same subject, (P value >0.05). Conclusion: The studyconcluded that there is no significant difference in nerve conduction velocity between righthandedand lefthanded subjects. Same finding was found between right and left sides of the same subject, inboth righthanded and lefthanded groups. This proved that nerve conduction velocity has no relationwith handedness.


ID : 200378


TITLE : LES DYSTROPHIES MUSCULAIRES PROGRESSIVES AU BURKINA FASO: ASPECTSéPIDéMIOLOGIQUES, CLINIQUES ET éVOLUTIFS INTRODUCTION

Author : A .Dabilgou [1] , C Napon [1] , JMA Kyelem [1] , A Drave [1] , Z Kambire [1] , J Kabore [1]

Affiliation : [1]Service de neurologie du CHU Yalgado Ouédraogo


ABSTRACT : Les dystrophies musculaires progressives au Burkina Faso: aspects épidémiologiques,cliniques et évolutifs Introduction Service de neurologie du CHU Yalgado Ouédraogo Les myopathiessont des pathologies rares, d’origine génétique touchant primitivement le muscle strié. Le service deneurologie du CHU Yalgado Ouédraogo et la Fondation FITIMA coopèrent ensemble depuis 2004 àla prise en charge médical des patients atteints de myopathie au Burkina Faso. Les auteursrapportent les résultats du suivi médical des patients. Methodologie Il s’agit d’une étude rétrospectiveportant sur tous les cas de myopathies suivis dans le service de neurologie du CHU YalgadoOuédraogo. Les caractéristiques épidémiologiques, cliniques et évolutives des patients ont étéanalysées. Résultats Dixsept patients atteints de myopathies appartenant à 18 familles ont été inclusdans notre étude soit au total. L’âge moyen de nos patients était de 19,82 ans avec des extrêmes de6 et 40 ans. Le sexe masculin était retrouvé dans 16 cas. Le début de la maladie survenait à l'âge de6 10 ans chez 9 patients. On notait une consanguinité parentale chez 2 patients et 6 cas demyopathie familiale. Le retard moteur était retrouvé chez 10 patients; L’examen neurologique notaitchez 15 patients une démarche dandinante. Quatre patients présentaient des signes cardiaques. Letaux de CPK moyen était de 3016,64 UI/l. Le diagnostic moléculaire notait 2 cas dedystrophinopathies, 1 cas de dysferlinopathie et un cas de myopathie congénitale. L’évolution cliniquea été marqué par un cas de décès. Conclusion Les myopathies posent un problème de diagnosticgénétique et moléculaire dans notre contexte. Motsclés: dystrophies musculaires progressives,neurologie, Burkina Faso


ID : 200382


TITLE : ASSESSMENT OF COGNITIVE FUNCTIONS IN DIABETES MELLITUS TYPE 2 IN CONGO

Author : OSSOUNGUIET PM [1] , MPANDZOU GA [1] , BANDZOUZINDAMBA B [1] , DOUNGOUNGANDZALI D [2] , MOTOULA LATOU DH [2] , SOUNGA BANDZOUZI EP [3] , MONABEKA HG [4]

Affiliation : [1]1. Department of neurology, University Hospital of Brazzaville, Congo 2. Faculty ofHealth Sciences of Brazzaville, Congo, [2]1. Department of neurology, University Hospital ofBrazzaville, Congo, [3]Faculty of Health Sciences of Brazzaville, Congo , 3. Department of neurology,Hospital of Loandjili, Pointe Noire, Congo, [4]4. Depatment of endocrinology, University Hospital ofBrazzaville, Congo


ABSTRACT : TOPIC: ASSESSMENT OF COGNITIVE FUNCTIONS IN DIABETES MELLITUS TYPE 2IN CONGO OSSOUNGUIET PM1,2, DOUNGOU NGANDZALI D1, MPANDZOU GA1,2, MOTOULALATOU DH1, SOUNGA BANDZOUZI EP2,3, BANDZOUZINDAMBA B1,2, MONABEKA HG2,4Department of neurology, University Hospital of Brazzaville, Congo Faculty of Health Sciences ofBrazzaville, Congo Department of neurology, Hospital of Loandjili, Pointe Noire, Congo Depatment ofendocrinology, University Hospital of Brazzaville, Congo Introduction. Diabetes mellitus and cognitiveimpairment, is two diseases occurring most often in the elderly. The impact of diabetes, on the onsetof cognitive impairment, is increasingly documented. The aim of our study was to evaluate thefrequency of cognitive impairment in Congolese diabetic type 2, to identify risk factors and assesstheir impact on quality of life. Methods: This is a case control study conducted from January to June2015 involving 100 diabetic patients and 100 nondiabetic subjects. This study took place inBrazzaville and PointeNoire. We used preferentially Grober and Bruschketest to assess cognitivefunction. Results. The frequency of cognitive disorders in diabetic patients was 57%. The mean ageof diabetic patients with cognitive impairment was 56.3. Sex ratio of patients with cognitive impairmentwas 0.6 (M/F). Risk factors influencing the onset of cognitive impairment in diabetes in our study wereage ≥ 60 years, hypertension, duration of diabetes up of 5 years, low sociocultural level, HyperLDL.Age ≥ 60years and hypertension were independent factors for developing cognitive impairment. Wenoted a 12.3% frequency of Alzheimer's disease; 15.7% of MCI; 12.3% impairment of thedysexécutive encoding, 24.1% of attentional disorder and 3.5% in frontal cortical dementia. Encodingimpairment was strongly associated to diabetes. Cognitive disorders have influenced the quality of lifeof diabetic patients only in univariate analysis. Conclusion: The cognitive disorders were found indiabetic patients. They are common from the age of 60. In diabetic patients blood sugar control hasnot demonstrated a protective effect Keywords: Type 2 diabetes, cognitive disorders, Grober andBruschke Test, Congo


ID : 200384


TITLE : ACCIDENTS VASCULAIRES CéRéBRAUX ISCHéMIQUES (AVCI) PAR CARDIOPATHIESEMBOLIGèNES (CE) EN MILIEU HOSPITALIER à COTONOU, BéNIN.

Author : GNONLONFOUN Dieu donné [1] , ADJIEN Constant [1] , GOUDJINOU Gérard [1] , GNIMAVO Ronald [1] , EKUE Wilfried [1] , HOUINATO Dismand [1]



ABSTRACT : Accidents vasculaires cérébraux ischémiques (AVCI) par cardiopathies emboligènes(CE) en milieu hospitalier à Cotonou, Bénin. 137 GNONLONFOUN Dieu donné1, ADJIEN Constant1,GOUDJINOU Gérard1, GNIMAVO Ronald1, EKUE Wilfried1, HOUINATO Dismand1 Introduction :L’inaccessibilité aux bilans cardiovasculaires engendre la méconnaissance des CE comme étiologiedes AVCI. Objectif : étudier les AVCI par CE et les facteurs qui leurs sont associés. Méthode : Ils’agissait d’une étude transversale, prospective, descriptive et analytique qui s’est déroulée du 1erNovembre 2014 au 31 Août 2015 qui a porté sur 104 patients présentant un AVCI confirmé parl’imagerie cérébrale. Les CE étaient l’arythmie cardiaque par fibrillation auriculaire (ACFA), le Flutterauriculaire, l’infarctus du myocarde (IDM), les valvulopathies et l’anévrisme du septum interauriculaire (ASIA). La variable dépendante était la cardiopathie emboligène. Les variablesindépendantes étaient sociodémographiques, les antécédents, le mode de vie, les données lors del’AVC. Le logiciel SAS 9.3 a servi de base à l’analyse des données. Résultats La fréquence des CEcomme étiologie des AVCI était 26% (28/104). Les ACFA représentaient 82% des cardiopathiesemboligènes et 22,8% des étiologies des AVCI. La fréquence des valvulopathies était de 3,5%, cellede l’IDM de 2,5%, et celle de l’ASIA était de 1,2% des AVCI. Les facteurs associés étaient l’âge(p=0,0396), et la topographie sylvienne de l’AVCI. Discussion/Conclusion La reconnaissance d’unesource cardiaque potentielle d’embolie est impérative du fait des implications thérapeutiques etpronostiques. C’est tout l’intérêt du bilan cardiovasculaire notamment le Holter ECG, l’échographiecardiaque qui ne sont pas toujours accessibles à nos populations. Mots clés : AVC, Ischémie,Cardiopathie emboligène, Bénin.


ID : 200387


TITLE : ANTIVGKC ANTIBODY MEDIATED LIMBIC ENCEPHALITIS IN A SUDANESE PATIENT:RARITY IN SUB SAHARAN AFRICA

Author : Mohamed Seidi [1] , Louai Mohamed [1] , Osheik Seidi [2]

Affiliation : [1]Aliaa Specialist Hospital, Omdurman, Sudan, [2]University of Khartoum, Sudan


ABSTRACT : AntiVoltage Gated Potassium Channel (VGKC) antibody limbic encephalitis (LE) is arare disorder with protean clinical presentations needing a high degree of clinical suspicion andadvanced immunological tests to confirm. The latter are usually not available in developing countries.We report the case of a sixty eight years Sudanese gentleman who developed subacute cognitivechanges with bizarre movements of his face and limbs. Followed in a short period by myoclonic jerkswith frequent falls with lapses in awareness. He was diabetic with excellent control. He has a strongfamily history of autoimmune disorders including SLE. Clinically, he had faciobracial dystonicmovements with myoclonic jerks on the limbs and infrequently spreading to the whole body. The restof the general and neurological examinations were unremarkable. An MRI of the brain revealed hyperintensities on the medial temporal lobes and basal ganglia. Surface EEG showed no significantabnormalities and all basic investigations were normal. Antinuclear and anti neurtophil cytoplasmicantibodies (ANA &ANCA) were within normal limits as well as the inflammatory markers. On apresumptive clinical diagnosis of VGKC antibody mediated limbic encephalitis he underwent fivesessions of therapeutic plasma exchange (TPE) and started on steroids and azathioprin. Hismyoclonic seizures were controlled with levetiracetam. His cognitive function came back to normal aweek after the TPE. He travelled to Thailand for further management and VGKC antibodies wereconfirmed to be strongly positive. Two months later has had a replace which responded to a secondsession of five plasma exchanges. Four months later he was back to his normal self. Extensivesearch for an underlying malignancy was negative. That included, tumour markers, CT scan of thethorax, abdomen and pelvis and a PET scan performed in Thailand. He remained stable on regularfollow up on reducing dose of oral steroid as well as levetiracetam and azathioprin. To the best of ourknowledge this is the first confirmed case of Anti VGKC antibody mediated LE from Sudan. A highindex of suspicion is needed to recognize this rare, serious but potentially treatable condition.Faciobrachial myoclonic jerks are a helpful sign particularly in resource limited countries. Therapeuticplasma exchange gave remarkable result in this case followed by immunosuppressant. It is importantto follow up these patients closely and they may relapse. A thorough search for underlyingmalignancy is important in elderly patients although the idiopathic autoimmune variety is seen acrossthe age groups.


ID : 200389


TITLE : CAUSES AND ISSUES OF STATUS EPILEPTICUS AT NEUROLOGY UNIT INBEFELATANANA

Author : Rakotomanana Jenny Larissa MD [1] , Raharimaminjatovosoa Doré Augustine MD [1] , Razafimahefa Julien MD [1] , Ravelosaona Fanomezantsoa MD [1] , Tehindrazanarivelo AlainDjacoba MD [1]

Affiliation : [1]Rakotomanana Jenny Larissa, registrar in neurology from faculty of medecineAntananarivo, Madagascar

TOPIC : Epilepsy

ABSTRACT : Introduction: The status epilepticus is an electroclinical syndrom, which is themaximum expression of epilepsy. Its causes are many. Its evolution can be disabling or even fatal. Inthis study, we will describe the causes and outcomes of patients in the reference Neurology unit inMadagascar. Methodology: A retrospective and descriptive study on epileptic patients hospitalizedfrom 01 January 2015 to 31 December 2016 was conducted. Included all patients with a statusepilepticus. The prevalence of causes and the correlation (p) between patient outcomes and theSTESS scale were analyzed. Results : we retained 235 status epilepticus, including 142 men and 93women (sex ratio: 1.5), with a middle age of 41.6 years. Only 17.87% of the cases presentedcomplications. Inhalation pneumonia was the most frequent complication and accounted for 71.42%of complicated cases. The status epilepticus causes were in descending order: toxic (37.02%),indeterminate (31.91%), infectious (12.34%), metabolic (8.08%), sleep deprivation (6.80%) andtrauma cranial (3.82%). Five (2.12%) of our patients died, 80% with a STESS scale ≥ 3 (p = 0.001).Discussion and conclusion : the status epilepticus is mostly found in young people, men,uncomplicated in most cases, due to a toxic cause, with a good outcome. Keywords : Causes Issues– status epilepticus


ID : 200390


TITLE : ALZHEIMER'S DISEASE AND OTHER DEMENTIAS

Author : I.A. CAMARA [1] , O.A. ORNELA [1] , A. NSOUNDA [1] , N. DIOUF [1] , L.L. DIALLO [2] , L.OURA [3] , P. KOUNANDOUONGO [4]

Affiliation : [1]Service de Neurologie, centre hospitalier universitaire de Libreville, Libreville, Gabon, [2]Service de Neurologie, centre hospitalier universitaire de Kipé, Conakry, Guinée, [3]Service deNeurologie, HIAOBO BP 20404, Libreville, Gabon, [4]Neurologie, université des sciences de la santé,Owendo, Gabon


ABSTRACT : Objectif : Lobjectif de notre tude tait dvaluer la prvalence des dmencesvasculaires en milieu hospitalier Libreville (Gabon). Mthode : ltude a t rtrospectivetransversale vise descriptive et analytique portant sur les dmences postAVC pendant lapriode du 1er Janvier 2012 au 31 Juillet 2015. Les tests neuropsychologiques (MMSE, DSMIV,HACHINSKI et NINDSAIREN) taient utiliss pour le diagnostic de la dmence vasculaire etlapproche de collecte tait une enqute par entretien suivi dun examen. Les donnescollectes taient traites et analyses avec le logiciel Epiinfo 2000. Rsultats : Cette tude aport sur 115 patients victimes dAVC dont 9 (7,8%) cas de dmence vasculaire. Parmi les patientsdmentson avait 6 (66,6%) hommes et 3 (33,3%) femmes gs de 26 84 ans avec unemoyenne de 55,8 ans et un cart type de 10,6 ans. Le test de HACHINSKI avait servi pour lediagnostic de la dmence vasculaire avec une sensibilit de 99,9%. Limagerie crbrale taitralise chez tous nos patients dont 8(88,9%) avaient une dmence postAVCI et 1(11,1%) avaitune dmence postAVCH. Conclusion : Ces rsultats suggrent queles AVCconstituent une destiologies des dmences les plus frquentes et le test Hachinski reste lexamen de choix pour ladmarche diagnostique. Mots cls : Dmence, AVC, Libreville. SUMMARY Objectve :The mainpurpose of the study was to evaluate the prevalence of vascular demencia in hospital of Libreville(Gabon) Methods :We include retrospectively 115 patients living with demencia post stroke during the1st january 2012 to 31 july 2015. The neuropsychologic test (MMSE, DSMIV, HACHINSKI andNINDSAIREN) was used for the diagnostic of vascular demencia. The data base wasanalysedwithEpiinfo. Results :In the population of 115 patient, we contabulase 7.8 percent with vasculardemencia. In the group of demencia patients 66.6 percent was males and 33.3percent was womens,the both beetwen 26 to 84years old. The middle age was 55.8 years and the ecarttyp 10.6 years.The Hachinski test was used for the diagnostic of vascular demencia with a sensibility of 99.9 percent.The cerebral scan was used for all the patients. In the group of demencia patients 8(88.9 percent)were having demencia post ischemia stroke and 1(11.1 percent) patient post hemorraege stroke.Conclusion :these results demonstrate that the stroke is the main etiology of demencia and theHachinski test is the gold standard for the diagnostic Key words : Demencia, Stroke, Libreville


ID : 200391


TITLE : ENCEPHALITE TOXOPLASMIQUE CHEZ UN SUJET IMMUNOCOMPETENT : A PROPOSD’UNE OBSERVATION

Author : Constance Apo YAPOEHOUNOUD [1] , AKAANGHUI DIARRA E [1] , JIONGO TIAGO EE[1] , TANOH AC [1] , AMONTANOH MT [1] , SOUMANA HF [1] , ASSI B [1]

Affiliation : [1]Service de Neurologie, CHU de Cocody, Abidjan, Côte d’ivoire


ABSTRACT : Introduction L'encéphalite toxoplasmique est une forme rare de toxoplasmosecérébrale et n’était rapportée jusqu'alors que chez l’immunodéprimé. Chez l’immunocompétent, peude cas existent. Dans un contexte clinique évocateur, doiton reconsidérer le diagnostic detoxoplasmose chez un immunocompétent ? Objectif Décrire un cas d’encéphalite diffuse évocateurd’une toxoplasmose chez un sujet immunocompétent. Observation Une cinquantenaire, VIH négative,hospitalisée du 26/12/16 au 06/01/17, a présenté une encéphalite diffuse, révélée par un trouble dela vigilance subfébrile progressif depuis 3 mois dans un contexte de fièvre au long cours etd’amaigrissement. Le tableau clinique initial reposait sur la classique triade de Bergman. L’imageriemontrait un œdème cérébral mal systématisé hémisphérique droit. L’enquête étiologique dans lesens d’une tuberculose ou d’une infection bactérienne à pyogènes ou d’une néoplasie n’a pas étécontributive. Une encéphalite toxoplasmique a été évoquée. Elle a reçu 960 mg de cotrimoxazole VOet un bolus de corticoïdes .Au bout d’une semaine, l’évolution a été favorable. Commentaires Lediagnostic des encéphalites toxoplasmiques n’est pas toujours évident dans un contexte à ressourceslimitées chez l’immunocompétent. Le mode de survenue progressif, les antécédents et le tableauclinique de nôtre patiente nous ont permis d’évoquer une encéphalite toxoplasmique, malgré lasérologie négative. Un cas similaire brésilien a été rapporté en 2001. Nous n’avons pas pu réaliser dePCR, ni de sérologie qui nous aurait conforté dans notre diagnostic. L’évolution sous traitementd’épreuve a été favorable, comme rapporté ailleurs. Conclusion Cette observation met en évidence latoxoplasmose comme une cause possible d’encéphalite chez l’immunocompétent Mots clés :toxoplasmose cérébrale, immunocompétent


ID : 200392


TITLE : ÉPILEPSIE SYMPTOMATIQUE CHEZ L'ENFANT

Author : JMA. Kyelem [1] , A. Dabilgou [1] , C. Napon [1] , J. Kabore [1] , A. Millogo [2]

Affiliation : [1]département de neurologie de l'Hôpital Universitaire Yalgado Ouédraogo, [2] Servicede médecine interne de l'Hôpital Universitaire Sourô Sanou

TOPIC : Epilepsy

ABSTRACT : Objectif: Déterminer les facteurs étiologiques et évaluer l’apport de l'imagerie cérébraleau diagnostic l'épilepsie symptomatique chez l’enfant. Méthode: Nous avons recueilli des dossiersd'enfants de 0 à 15 ans qui avaient consultés pour une épilepsie de janvier 2015 à octobre 2016. Lespatients ayant un examen clinique et / ou une imagerie cérébrale anormale étaient sélectionnés.Résultats: L'âge moyen des patients était de 58 mois [4 mois, 15 ans]. Le sexratio était de 1,36.Dans les antécédents on retrouvait une prééclampsie pendant la grossesse dans 12,8%. La dystocielors de l’accouchement avec une souffrance fœtale aiguë représentait 36,1%. Les antécédentspathologiques postnataux représentaient 48,4% des cas avec prédominance d'ictère néonatal etd'infections du système nerveux central. Les crises épileptiques ont été généralisées dans 93,8% descas et focalisées dans 6,2% des cas. L'examen neurologique a révélé un déficit moteur souventassocié à un déficit cognitif de 47,4% et un déficit cognitif seulement à 36,1%. L'examen était normaldans 15,5%. L'électroencéphalogramme était anormal chez 64,9%; Les anomalies paroxystiquesfocales étaient fréquentes (90,5%). La tomodensitométrie cérébrale a été réalisée dans 72,2% descas avec des résultats pathologiques dans 74,3% des cas (atrophie corticale 40,9%, lésions hypoxoischémiques 18,3%). L'IRM représentait 27,8% des cas avec un résultat pathologique de 79,4%(atrophie corticale 41,2%, atrophie hippocampique 23,5%). Conclusion: Les épilepsiessymptomatiques sont fréquentes. La souffrance fœtale aiguë et les infections du système nerveuxcentral sont les causes les plus fréquentes. La tomodensitométrie reste l'imagerie première intentiondans un pays à ressources limitées


ID : 200393


TITLE : ÉPILEPSIE TEMPORALE DE L'ENFANT: ASPECTS CLINIQUES ET THéRAPEUTIQUES

Author : Kyelem JMA [1] , A. Dabilgou [1] , C. Napon [1] , EA. Carama [1] , A. Millogo [2] , J.Kabore [3]

Affiliation : [1] Département de Neurologie, Hôpital Universitaire Yalgado Ouédraogo, [2]Département de Médecine, Hôpital Universitaire Sourô Sanou (Bobo Dioulasso, BF), [3]Département de Neurologie, Hôpital Universitaire Yalgado Ouédraogo

TOPIC : Epilepsy

ABSTRACT : Objectif: Décrire les aspects cliniques et thérapeutiques de l'épilepsie temporale del'enfant Méthode: Étude descriptive transversale réalisée au service de Neurologie de mars 2015 ànovembre 2016, treize dossiers ont été sélectionnés. Résultats: L'âge moyen des patients était de 7ans avec un sex ratio de 1,16. Une souffrance fœtale aiguë était retrouvée dans 54% des cas. Neufpatients avaient présenté des crises généralisées incluant des crises tonicocloniques (5), des crisesd'absences (3) et des crises atoniques (1). Deux patients avaient des crises motrices focalessecondairement généralisées. Des troubles du comportement isolés étaient présents chez deuxpatients. Le déficit cognitif était présent dans 76,92% des cas avec des troubles du comportement(hyperactivité, perte des conduites sociales) et des troubles du langage. Les anomalies paroxystiquesobservées étaient de topographie centrotemporale (6), frontale (2), frontotemporale (1) et occipitale(1). L’EEG était normal chez 2 patients.L'IRM cérébrale réalisée chez 8 patients révélait une sclérosebilatérale de l'hippocampe (7) et une tumeur dysembryologique neuroépithéliale du lobe temporalgauche. Une tomodensitométrie cérébrale réalisée dans 5 cas a révélé une atrophie frontotemporale (3), une cavité porencéphalique temporale (1) et une atrophie corticale associée à deslésions ischémiques anoxiques (1).Concernant le traitement, 3 patients étaient sous monothérapie et10 patients étaient sous bithérapie. Les molécules utilisées étaient l'acide valproïque, le clonazépamet la lamotrigine. CONCLUSION: Les facteurs favorisant de l’épilepsie temporale sont lescomplications anoxoischémiques au cours de l’accouchement. La sclérose hippocampique est lalésion prédominante. L’association de plusieurs médicaments antiépileptiques est fréquente


ID : 200394


TITLE : EPILEPSY IN DEVELOPING COUNTRIES: A COHORT OF 662 PATIENTS IN NIGER

Author : ASSADECK hamid [1] , BOUBACAR Soumaila [2] , TOUDOU DAOUDA, Moussa [3] , MAIGA Douma Djibo [4]

Affiliation : [1] Department of internal medicine and medical specialties, Niamey, Niger , [2]Neurology Department, CHU Fann, Dakar, Senegal , [3] Neurology Department, CHU Hassan II,Fez, Morocco, [4] Faculty of health, Abdou Moumouni University, Niamey, Niger

TOPIC : Epilepsy

ABSTRACT : Introduction: Epilepsy is defined as a chronic disorder of the central nervous systemcharacterized by recurrent seizures. In Niger, African subsaharan country, few studies were devotedto this affection. Objectives: To analyze the epidemiological, clinical and etiological aspects of epilepsycases in the neurology outpatient clinic of Niamey (capital of Niger). Patients and method: It wasabout a prospective study conducted to the neurology patient clinic in Niamey during 19 months from16/09/12 to 16/04/14. Were included all patients with epilepsy during the study period. Results: Thestudy concerned 662 epileptic patients accounting for 30% of all neurology outpatients. The sex ratio(M/F) was of 1,67. The seizures were generalized in 66,3% of the cases and partial in 29% of thecases. The age of onset was before 15 years of 58% of the patients. Epilepsy in elderly patients wasnot common. Among 134 patients (20%) only one factor etiologic had been found. Epilepticencephalopathies, cerebral malaria and obstetrical traumas were the most frequent risk factors.Conclusion: Epilepsy is a frequent affection in external consultation of neurology in Niamey. Widesensitization will be needed. Control of risk factors will be highly contributory in the fight againstepilepsy in Niger. Keywords : EpilepsyEpidemiologyOutpatient clinicNiger.


ID : 200395


TITLE : EXISTETIL UN LIEN CAUSAL ENTRE L’HYPERTHYROIDIE ET L’ACCIDENT VASCULAIRECEREBRAL ISCHEMIQUE ?

Author : Muriel Amon Tanoh [1] , Evelyne AkaDiarra [1]

Affiliation : [1]Département de Neurologie CHU de Cocody Abidjan Cote d'Ivoire


ABSTRACT : Introduction: La fibrillation auriculaire (FA) est le trouble du rythme le plus fréquent,observé dans la cardiothyréose. Nous rapportons un cas d’hyperthyroïdie associé à un accidentvasculaire cérébral ischémique (AVCI). Cas clinique: Ménagère âgée de 72 ans, de latéralité droite,tabagique, porteuse d’un goitre, et HTA de découverte fortuite. Elle a été hospitalisée pour un AVCIsylvien superficiel bihémisphérique responsable d’une hémiparésie gauche associé à une dysarthrie.A l’admission, la TA était à 150/100mmhg, le pouls à 150 battements/minutes et un score NIHSS à 4.Le bilan étiologique a permis de montrer une FA avec hypertrophie ventriculaire gauche àl’électrocardiogramme. Le doppler cardiaque a mis en évidence une cardiopathie ischémique avecFEVG à 48%. Le bilan thyroïdien a permis d’objectiver une thyréotoxicose avec hyperthyroïdie (TSHeffondrée < 0,005µUI/ml avec augmentation de T3 : 7,98Pg/ml et T4 : 27,33ng/l).Elle a bénéficiéd’une prévention secondaire (amlodipine+périndopril 5mg/j, rovustatine 5mg/j, clopidogrel 75mg/j,acide acétyl salicylique 100mg/j avec HASBLED à 4/9) et d’adjonction de propanolol 40mg/j etthyrozol 80mg/j en 2prises. L’évolution fut favorable avec amélioration lente des signes decardiothyréose. Discussion: Dans notre observation, l’hyperthyroïdie s’est compliquée d’une FA avecdes signes de cardiothyréose pouvant mettre en péril le pronostic vital. La FA a entrainé l’AVCI parmécanisme thromboembolique chez cette patiente avec un score intermédiaire de CHAD2VASC2 à5/9. Conclusion: L’association FA hyperthyroïdie est fortuite. Il convient donc de rechercher une FAchez tout patient présentant un AVCI avec hyperthyroïdie associée ou non à un goitre. Mots clés:AVCI FA hyperthyroïdie cardiothyréose


ID : 200396


TITLE : FINANCIAL COSTS OF STROKE AT THE FANN'S NATIONAL TEACHING HOSPITALCENTER IN DAKAR

Author : Daniel ATSA KOUDA [1] , Mohamed Lelouma MANSARE [1] , Marcellin BUGEME [1] , [2] , [2]

Affiliation : [1]Fann National Teaching Hospital of Dakar, [2]


ABSTRACT : BACKGROUND Stroke is a health burden for subSaharan African countries. Theobjective of the study was to evaluate the financial costs of hospital management of stroke at theNational Teaching Hospital Center (NTHC) of Fann in Dakar. PATIENTS AND METHODS This is aretrospective work over six months, from July to December 2016 conducted at the Neurological Clinic.Hospitalized patients with stroke aged more than 15 years were included. Cerebral venousthrombosis and subarachnoid haemorrhage were excluded. The qualitative and quantitative variableswere compared with the Chi2 and Student tests. RESULTS A total of 79 patients were included. Therewere 32 women and 47 men. The mean age was 58.5 ± 14.8 years. The hemorrhagic strokeaccounted for 35.8%, and ischemic troke accounted for 64.2%. The mean length of hospital stay was14.1 ± 12.2 days. The total financial cost of stroke for the period amounted to CFAF 20,724,917 (EUR31,595). The average cost was 265,704 FCFA (EUR 405,1)per patient or 5.6 times the IGMW inSenegal. The daily cost was 18,671 FCFA (EUR 28,5) per patient. There was no significant differencein cost between ischemic and hemorrhagic strokes. Explorations accounted for 42.6% andadministrative expenses for 38.4% of all the costs . CONCLUSION The financial cost of hospitalizedstroke is high. Measures should be taken by the authorities to depreciate family expenses.KEYWORDS StrokeFinancial costDakarSenegal


ID : 200397


TITLE : FREQUENCE ET CARACTERISTIQUES DES ESCARRES AU COURS D’UN ACCIDENTVASCULAIRE CEREBRAL AU SERVICE DE NEUROLOGIE HUBEFELATANANA

Author : RAVELOSON Fanomezantsoa [1] , RAZAFINDRASATA Santatra [1] , RAJAONARISONAndriamasinavalona [1] , RAZAFIMAHEFA Julien [1] , TEHINDRAZANARIVELO Alain [1]

Affiliation : [1]Faculté de Médecine de l’Université d’Antananarivo Madagascar


ABSTRACT : Introduction : Une escarre est une nécrose ischémique des tissus, provoquée par lacompression entre deux plans durs. Elle est l’une des complications de décubitus la plus fréquente aucours d’un alitement prolongé. L’accident vasculaire cérébral (AVC) est l’une de ses principalescauses. Afin de mieux prévenir ces escarres, nous avons voulu savoir leur fréquence etcaractéristiques au cours des AVC dans notre service. Méthodes : Une étude descriptiverétrospective fut effectuée au service de Neurologie de l' Hôpital Universitaire (HU) Befelatananaentre Janvier et Août 2015. Nous avons inclus tout patient ayant un déficit neurologique brutal avecou sans scanner, non décédé au cours de l’hospitalisation. Nous avons utilisé le logiciel epiinfo 7pour traiter les données. Résultats : Cent cinquantesept AVC (95,73%) étaient retenus sur les 164admis durant ces 8 mois. Vingtcinq sujets (15,24%) présentaient des escarres. Dixneuf (76%)survenaient dans le service. Elles apparaissaient en moyenne après 5,32j pour une durée moyennede séjour hospitalier de 11,72 jours. L’âge moyen de survenue des escarres était de 62,64 ans avecune prédominance féminine. Les premiers AVC de nature inconnu (44%) et le stade IIa des escarres(52%) prédominaient. La localisation principale des escarres était fessière dans 92 % des cas.Conclusion : Les escarres sont encore fréquentes malgré le nursing en neurologie. La coopérationentre personnel soignant et la famille est une solution que nous avions trouvé pour les éviter pourl'instant vu nos manques de matériels et de personnels. Mots clés : accident vasculaire cérébral,complications de décubitus, escarre, neurologie HUBefelatanana


ID : 200398


TITLE : GELASTIC SEIZURES REVEALING HYPOTHALAMIC HAMARTOMA

Author : DOUMBIAOUATTARA M [1] , KOUASSI KL [1] , DIAKITE I [1] , YAPOEHOUNOUD C [1] , BROH Y [1] , DOUAYOUASONAN T [1]

Affiliation : [1]Department of Medical Sciences, Félix Houphouët Boigny University, BP V 166,Abidjan, Ivory Coast

TOPIC : Epilepsy

ABSTRACT : Introduction: Les crises épileptiques gélastiques sont rares et le plus souventsymptomatiques d’un hamartome hypothalamique (HH) Cas clinique: Nous rapportons le cas d’unefillette de 7 ans, adressée pour des épisodes de rupture de contact avec des automatismes gestuels,et des troubles du comportement à type de fous rires non motivés, grimaces et monologues. Cesépisodes évoluent depuis l’âge de 3 ans, et sont devenues plus fréquentes depuis 2 ans, dans uncontexte de régression franche des capacités intellectuelles. Les antécédents sont marqués par unesouffrance cérébrale néonatale modérée. L’examen somatique notait une puberté précoce et unesurcharge pondérale. L’évaluation neuropsychologique situait les épreuves intellectuelles et delangage à environ 4 ans. L’EEG de veille montrait de nombreuses bouffées brèves de pointes,pointesondes et polypointes diffuses, bilatérales, accrues lors de l’hyperpnée et très abondantesdans le sommeil, prédominant sur les régions centrales et temporales, à maximum gauche. L’IRMencéphalique a mis en évidence une masse tumorale hypothalamique au niveau du plancher du3ème ventricule évocatrice d’un hamartome. Une déconnexion a été réalisée permettant ladiminution de la fréquence et de la durée des manifestations épileptiques, mais la persistance degros troubles du comportement. Discussion: L’hamartome hypothalamique, tumeur neurale bénignerare à l’origine d’épilepsie, est fréquemment révélé par des crises gélastiques et une pubertéprécoce. Conclusion: L’hamartome hypothalamique doit toujours être évoqué devant des crisesgélastiques, permettant ainsi un diagnostic précoce, afin d’améliorer le pronostic cognitif des patients.Motsclés: crises gélastiques, hamartome hypothalamique, enfant


ID : 200400


TITLE : GLIOBLASTOME MEDULLAIRE DE L’ENFANT : A PROPOS D’UN CAS ET REVUE DE LALITTÉRATURE

Author : AngeEric KOUAMEASSOUAN [1] , Aderehime HAIDARA [1] , Hyénéya ArmelKARIDIOULA [1] , Assata SYLLA [1] , Brahima DOUKOURE [2]

Affiliation : [1]Université Alassane Ouattara et CHU de Bouaké, [2]Université Félix HouphouëtBoigny et CHU de Cocody

TOPIC : Other

ABSTRACT : GLIOBLASTOME MEDULLAIRE DE L’ENFANT : A PROPOS D’UN CAS ET REVUE DELA LITTERATURE Auteurs : AngeEric KOUAMEASSOUAN1, Aderehime HAIDARA1, BrahimaDOUKOURE2, Hyénéya Armel KARIDIOULA1, Assata SYLLA1 1 : Université Alassane Ouattara etCHU de Bouaké 2 : Université Félix Houphouët Boigny et CHU de Cocody Correspondance : DrAngeEric KOUAMEASSOUAN Maître de Conférences Agrégé de Neurologie Université AlassaneOuattara, UFR Sciences Médicales CHU de Bouaké, Service de [email protected] Téléphone mobile : +225 07760457 Résumé : Nous rapportonsl’observation rare d’un glioblastome médullaire chez un enfant de 13 ans sans antécédent particulier,révélé brutalement le matin au réveil, par une hémiparésie droite flascospasmodique, sans troublessensitifs, épargnant la face, associée à des douleurs cervicales. L’IRM médullaire a permis de mettreen évidence un processus occupant intramédullaire étendu de la jonction bulbomédullaire à C4C5,d’allure tumorale, dont l’exérèse chirurgicale a conduit au diagnostic anatomopathologique deglioblastome. Au regard de la rareté de ce type de tumeur, en particulier chez l’enfant, nous endiscutons les aspects radiocliniques et thérapeutiques au travers d’une revue de la littérature


ID : 200401


TITLE : HEMICHOREA REVEALING DIABETES

Author : brahem zeineb [1] , I. Bedoui [1] , J. Zaouali [1] , M. Mansour [1] , A. Riahi [1] , H. Derbali[1] , M. Messelmani [1] , R. Mrissa [1]



ABSTRACT : INTRODUCTION: Unbalanced diabetes can be responsible for various neurologicalmanifestations such as seizures and unconsciousness. A rare manifestation is the appearance ofmovement disorders such as hemichorea. CASE REPORT: Three patients (one man and 2 women)with an average age of 60 years had presented a sudden installation of abnormal movements of thehemibody without further associated neurological signs. The biological sample showed hyperglycemiawithout ketosis. CT scan showed spontaneously hyperdense lesions of the basal ganglia in allpatients. They received haloperidol with gradual correction of glycemia. The normalization of theblood glucose allowed a spectacular disappearance of the chorea in all patients with an averageduration of 10 days. DISCUSSION: Chorea is an hyperkinetic movement disorder characterized bythe occurrence of uncontrollable, abrupt, irregular movements of all or part of the body. It revealsrarely diabetes and it can be associated with hyperglycemia without ketosis. The etiopathogenicmechanism is unknown. CT scan showed spontaneous hyperdensity at basal ganglia with aninvolvement of the putamen in 100% of cases. The lesions are often unilateral, however, bilateralinvolvement has been reported. In cerebral MRI, the typical sign is the putaminal hypersignal on T1sequence. Management consists initially in the equilibration of diabetes then the administration ofhaloperidol or tetrabenazine. The clinical evolution is generally favorable (97.4% of patients recovercompletely within 6 months). CONCLUSION: The abrupt installation of movement disorders such aschorea or hemiballism must always evoke a metabolic cause such as hyperglycemia without ketosiswhich is a curable cause.


ID : 200404


TITLE : HéMORRAGIES INTRAPARENCHYMATEUSES CéRéBRALES: éPIDéMIOLOGIE ETPRONOSTIC à DOUALA, CAMEROUN.

Author : mapoure N yacouba [1] , Khadidja A [1] , Mouelle AS [1] , Luma NH [1] , Njamnshi AK [1]

Affiliation : [1]


ABSTRACT : Introduction: Les hémorragies intraparenchymateuses cérébrales (HIC) représententune forme grave d’accident vasculaire cérébral (AVC). Objectif: Décrire les aspects épidémiologiqueset évaluer le pronostic vital et fonctionnel à court terme. Méthodologie: Il s’agissait d’une étude decohorte rétrospective sur 6 ans menée à l’Hôpital Général de Douala. Etaient inclus les patients âgésde > 15 ans ayant un diagnostic d’HIC confirmé par imagerie cérébrale. Les hémorragies méningéeset les causes secondaires d'HIC étaient exclues. Le pronostic fonctionnel a été évalué par le score deRankin modifié. Les facteurs prédictifs de mortalité et de dépendance fonctionnelle ont étédéterminés par l’analyse multivariée selon le modèle de Cox. Résultats: Au total, 261 cas d’HICétaient inclus avec un âge moyen de patients de 55,6 ± 11,8 ans et un sexratio de 1,77. Lesprincipaux facteurs de risque cérébrovasculaire étaient l'hypertension artérielle (73%), l'obésité(43%) et le diabète (39%). La mortalité intra hospitalière était de 39,8%. Les facteurs prédictifsindépendants de mortalité intra hospitalière étaient le score de Glasgow 8/15 (p=0,036, OR=3,538, ICà 95% = [1,086 11,526]) et le score de NIHSS > 15 (p=0,024, OR=7,498, IC à 95% = [1,306 43,029]). La dépendance fonctionnelle était de 50% à 3 mois post HIC avec comme facteursprédictifs de mauvaise récupération : l’effet de masse au scanner (p<0,001, OR=7,315 [2,530 21,151]), l’hyperthermie (p=0.015, OR=4,645 [1.34116.088] et la durée d’hospitalisation > 8 jours (p= 0,044, OR=2,951 [1,030 8,457]). Conclusion: La mortalité est élevée au cours des HIC. Laprévention primaire doit être de mise dans notre contexte. Mots clés: Hémorragie intracérébrale,facteur de risque cérébrovasculaire, mortalité, récupération fonctionnelle.


ID : 200406


TITLE : INFLUENCE OF DIETARY SALT KNOWLEDGE, PERCEPTIONS AND BELIEFS ONCONSUMPTION CHOICES AFTER STROKE IN UGANDA

Author : Martin N. Kaddumukasa [1] , Elly Katabira [1] , Martha Sajatovic [1] , Svetlana Pundik [1] , Mark Kaddumukasa [1] , Larry B Goldstein [1]

Affiliation : [1]


ABSTRACT : Influence of dietary salt knowledge, perceptions and beliefs on consumption choicesafter stroke in Uganda 150 Martin N. Kaddumukasa*, Elly Katabira, Martha Sajatovic, SvetlanaPundik, Mark Kaddumukasa, Larry B Goldstein. In Uganda, >65% of stroke survivors haveuncontrolled hypertension. Only 39% of the population was found to have adequate saltdiseaseknowledge but this didn’t translate into healthier consumption choices (1). We aimed to identifybarriers and motivators to healthy dietary compliance and examine the understanding of widelyaccepted salt regulation mechanisms among poststroke patients in Uganda. Utilizing a convergentparallel mixed methods design comprising of a quantitative cross sectional survey (n=81) and 8qualitative Focus Group Discussions of 710 adults each, we were able to assess demographic andclinical characteristics and obtain insights into their salt consumption attitudes, perceptions andknowledge. Qualitative responses were analyzed using an inductive approach with thematic analyticprocedures. Regression models were used to determine patient and clinical characteristicsassociated with dietary salt knowledge Objective knowledge assessments from our study found only14.8% had correct dietary salt knowledge. The primary source of healthrelated salt knowledge weremedia personalities (44%) compared to medical (20%) or educational sources (7%). 92% ofparticipants had no understanding of nutrition labels and ~25% of the study population consumedpotash – an inexpensive salt substitute both potassiumrich and sodiumpoor. The primary barrier tohealthy consumption choices among Uganda’s stroke survivors is limited access to credible diseaserelated information stemming from a lack of accurate saltdisease knowledge especially among healthpersonnel at primary strokecare points. There is need to enhance identified motivating factorsincluding potash use and exploration of practices that can more effectively exploit the gap betweensaltdisease knowledge and patient centered behavioral rehabilitation. References 1. KaddumukasaMN, Elly Katabira, Martha Sajatovic, Svetlana Pundik, Mark Kaddumukasa, Larry B. Goldstein.Influence of sodium consumption and associated knowledge on poststroke hypertension in Uganda.Neurology. 2016;87:1198 205. *Corresponding author: Martin N. Kaddumukasa; Email:[email protected]; Tel: +256772120965


ID : 200410


TITLE : INVESTIGATION OF FAMILIAL CASES OF MULTIPLE SYSTEM ATROPHY (MSA) IN THECOMMUNE OF THIES, SENEGAL

Author : Kamadore Touré [1] , Moulid Ali Maidal [2] , Ndèye Fatou Ndoye [2] , Adjaratou Sow [2] , Anna Basse [2] , Moustapha Ndiaye [2] , Amadou Gallo Diop [2] , Mouhamadou Mansour Ndiaye [2]

, Moustapha Diop [3] , Mamadou Moustapha Sarr [4] , Abdoulaye Diallo [4] , Fatou Seck [4] , Mamadou Mourtala Ka [4] , Abdoulaye Dione Diop [5]

Affiliation : [1]Department of Health Sciences, University of Thies, Senegal, Department ofNeurology, Fann University Hospital, Dakar, Senegal, [2]2.Department of Neurology, Fann UniversityHospital, Dakar, Senegal, [3]3.DHealth District of Thies, Senegal, [4]1.Department of HealthSciences, University of Thies, Senegal, [5]


ABSTRACT : Summary Introduction. Multiple System Atrophy (MSA) is a progressive, lethal andneurodegenerative disorder. Classified in two different forms (Parkinsonian and Cerebellar forms), itis considered as sporadic. However, few authors have described familial cases in western countriesbut not in Africa. The objective of this study was to describe the sociodemographic, clinical and,paraclinical characteristics of Senegalese familial cases of MSA. Patients and Methods. Through aninvestigation, we conducted an investigation of familial cases of MSA in the Commune of Thies,Sénégal. We realized a cross sectional study among families living the Commune from December2015 to May 2016 where patients presenting diagnostic criteria of MSA were included withoutlimitations of age. Data on sociodemographic and clinical characteristics of patients were collectedfrom the patients or their families. MRI of the brain, EMG, Auditory Evoqued Potential were performedon 4 patients from different families. Results. They were 21 patients (prevalence of 3.1 case/ 100 000habitants) with a mean age of 44.2 years (+/ 18.8), median of 45 years and a sex ratio de 0.6 (morefemale). The mean age of onset of the disease onset was 32.8 years (+/ 19.6) with a mean age ofduration of 11.2 years (+/ 7.7). Clinically, 20 (95.2%) patients presented a cerebellar form and 4.8% aParkinsonian one. All the patients had a pyramidal syndrome associated with dysautonomia (24%),dysphagia (43%), hypoacousia (19%), sensitive dysfunction (14%), cognitive deterioration (9.5%) andsleep dysfunction (9.5%). MRI of the brain realized on 4 patients from different families showedatrophy of the brainstem (saber sign), the cerebellum (Nébéday Leaf sign) with the ‘pontine crosssign’ and a bilateral cortical atrophy of the parietal lobe in one patient .The ENMG of these fourpatients showed a sensitive polyneuropathy of the four limbs and the auditory evoked potentialsindicated bilateral damage of the VIII cranial nerves. Conclusion. The description of familial cases ofMSA suggests the genetic implication however any mutation hasn’t been identified yet. Through ourstudy revealing many familial cases in different families, a recessive autosomic transmission issuspected. It is necessary to pursue genetics investigation to isolate genes for prevention. Keywords.Multiple System Atrophy, Heredity; Genetics; Thies; Senegal


ID : 200412


TITLE : LES POLYRADICULONéVRITES AIGUES : SYNDROME DE GUILLAINBARRé à PROPOSDE 39PATIENTS COLLIGéS AU CHNU DE FANN

Author : Anna Modji Basse [1] , SOW A.D [1] , NDIAYE M [1] , NDONG M.E.Y [1] , DIAGNE N.S [1] , DIOP M.S [1] , GAYE N.M [1] , TOURE K [1] , DIOP A.G [1] , NDIAYE M.M [1]



ABSTRACT : Introduction : Au Sénégal, les polyradiculonévrites aigues (PRNA)principalement lesyndrome de GuillainBarré affecte majoritairement les jeunes. L’objectif de ce travail estde préciserle profil épidémiologique, clinique, électrophysiologique, thérapeutique et évolutif des patients atteintsde PRNA à partir d’une série hospitalière. Patients et méthode :Il s’agit d’une étude rétrospectiveportant sur des dossiers de patients hospitalisés, entre le 1er janvier 2010 et le 30 juin 2016, auservice de Neurologie du centre hospitalier national de Fann. Résultats : Nous avons colligé 39patients dont 27 femmes (69,2%). L’âge moyen était de 33,9 ans.Un épisode infectieux a précédél’installation du tableau neurologique chez 17 patients (43,6%). Une progression ascendante dudéficit était notée chez 37 malades (94,7%) et le déficit moteur était symétrique chez 23 patients(58,9%). L’électroneuromyogramme montrait une perte axonale associée à la démyélinisation dans 9cas (27,3%).Une dissociation albimunocytologique du liquide céphalorachidien était notée chez 10patients (38,5%). La sérologie rétrovirale et l’AgHBsétaient positives respectivement chez un patient.Une corticothérapie était instaurée chez 20 patients dont 66.66% dans les formes démyélinisantes et33,33% axonomyéliniques.Trente et un patients (79,48%) présentaient des séquelles motrices à lasortie d’hospitalisation. Conclusion : Les polyradiculonévrites aigues restent une pathologie rare avecune fréquence hospitalière élevée. Une prise en charge précoce est préconisée


ID : 200413


TITLE : MEDICAL CARE OF EPILEPSY IN A SEMIURBAN AREA IN BURKINAFASO: CHALLENGESAND PROSPECTS. EXAMPLE OF THE HOSPITAL REGIONAL CENTER OF OUAHIGOUYA. ABOUT110 PATIENTS.

Author : A. DRAVE [1] , C. NAPON [2] , DABILGOU [2] , M. J. KYELEM [2] , O. DIALLO [2] , B. J.KABORE [2] , R. KABORE [3] , L. D. LOMPO [3] , D. SANKARA [4] , H. KABORE [4]

Affiliation : [1]1: University Hospital Regional Center of Ouahigouya., [2]2: National UniversityHospital Center Yalgado Ouedraogo of Ouagadougou., [3]3 :University Hospital Center BlaiseCompaore of Tengandogo of Ouagadougou., [4]4 : Medical Imaging Center of Ouagadougou.

TOPIC : Epilepsy

ABSTRACT : Purpose: Epilepsy is a chronic brain disease, affecting 2.4 million people annually in theworld. Its diagnosis is not always easy. It can be easily treat. We propose to describe the clinicalprofile, electro clinical, imaging and treatment of our patients. Method: Prospective descriptive studyon the period of September 2015 to December 2016, about 110 epileptic patients in GeneralMedicine at the Hospital Regional Center of Ouahigouya. Results: The average age of the patientswas 18 years with extremes of 7 months and 60 years. The sex ratio was 1.8. Academic problemswere objectified in 65 patients. The seizures were immediately widespread in 46 patients and ondriving and focal seizures in 64 patients. History were more represented by suffering fetal acute.Neurological examination found abnormalities in 32 patients. The magnetic resonance imagingperformed in 8 patients was pathological in 5 patients of which 2 cases of bilateral hippocampalsclerosis and 3 cases of unilateral hippocampal sclerosis. The brain scan noted 16 anoxoischemiclesion cases. 62 patients responded favorably to monotherapy treatment and 10 in the therapycombination. 38 cases of therapeutic window. Conclusion: The diagnosis of epilepsy, sometimesdifficult, requires a thorough investigation of the crises, physical examination,electroencephalography, tomodensitométric and magnetic resonance imaging. Treatment is easy, butthe molecules are unavailable. Key Words: EpilepsySemiUrbanBurkinaFaso.


ID : 200414


TITLE : MENSTRUALLYRELATED HEADACHES AMONG NIGERIAN HIGH SCHOOL ADOLESCENTGIRLS.

Author : Philip B.Adebayo [1] , FolajimiM Otubogun [2] , Rufus OAkinyemi [3]

Affiliation : [1]1. Ladoke Akintola University of Technology and Teaching Hospital, Ogbomoşo, Nigeria,2. Federal Medical Centre, Abeokuta, Ogun State Nigeria., [2]2. Federal Medical Centre, Abeokuta,Ogun State Nigeria., [3]2. Federal Medical Centre, Abeokuta, Ogun State Nigeria.3. Institute forAdvanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria.

TOPIC : Other

ABSTRACT : Abstract: Introduction: Migraine is twice as prevalent in females as in males especiallyafter puberty.Migraine attacks associated with menstruation are generally perceived as more severethan attacks outside this period.There is paucity of datadriven scientific reports from subSaharanAfrican on the burden of menstrually related migraine especially among adolescents. Aim andObjective: The study aimed at determining the frequency of menstrually related headaches among acohort of senior secondary school girls in Abeokuta, Nigeria. We also aim to document its burdenamong these school girls. Methodology: This study was crosssectional using a validated adolescentheadache survey questionnaire. Selfadministration of the instrument was done during a school visit.A headache was classified using the ICHDII criteria. Results: Of the 183 students that wereinterviewed, 123(67.2 % ) had recurrent headaches. Mean age ±SD, 16.18±1.55 (range 1219)years.Among the cohort with recurrent headaches, 21(17.1%) had migraine headaches, 16(13%) hadpossible migraine, 50(40.7) had tension type headaches while other headaches type were 21(17.1%).Twentysix subjects (21.1%) had menstrually related headaches (MRH). The mean age of subjectswith MRH and those without MRH was 16.52± 1.80 and 16.09±1.48 (p value=). Median pain severityscore was higher among MRH group (p=0.043).The median number of days of reduced productivitywas significantly higher in the MRH group (p=0.001). So also was the median number of days ofmissed social activities (p=0.03). Conclusion: Menstrually related headache is prevalent even amongthe adolescent and it has adversely affected their productivity and social life.


ID : 200415


TITLE : MYASTHéNIE AMYOTROPHIANTE AVEC ANTICOPRS ANTI MUSK POSITIVE : à PROPOSD'UN CAS

Author : Latifa .BERRHOUTE [1] , N .LOUHAB [1] , N.KISSANI [1]

Affiliation : [1]Service de neurologie, CHU Med VI, Marrakech


ABSTRACT : Introduction : La myasthénie avec anticorps anti Musk positif représente 40 % desmyasthénies séronégatifs, elle constitue une entité particulière avec des particularités cliniques,pronostiques et thérapeutique . Observation : Patiente de 30 ans, sans ATCDS pathologique, quiprésente de façon progressives des troubles oculaires faits de diplopie et un ptosis à bascule, unefatigabilité généralisée fluctuante suivie des troubles de mastication, de phonation et de déglutition.Le diagnostic de la myasthénie auto immune a été retenue devant la symptomatologie clinique , lesdonnées EMG et la positivité des anticorps anti Musk, la patiente a été mise sous traitementanticholinésthérasiques , avec une mauvaise évolution clinique et une mauvaise observance dutraitement. Patiente a été hospitalisé : l’examen clinique a objectivé une amyotrophie généralisée,ROT présents, ophtalmoplégie externe, diplopie, ptosis bilatéral , voix nasonnée , biparésie facialeavec une dysarthrie paralytique. Le test à la prostigmine était négatif avec des signes de mauvaisetolérance , L’ENMG a été en faveur de l’atteinte de la JNM et l’étude de l’activité musculaire montreune atteinte myogène . Le diagnostic de myasthénie à anticorps anti Musk est retenue, la patiente estmise sous azathioprine et corticothérapie orale avec une bonne évolution. Conclusion : Lamyasthénie avec anticoprs anti Musk est une entité particulière qui se caractérise par uneparticipation bulbaire et respiratoire importante avec la présence d’une atrophie linguale etmassétérine . La réponse aux anticholinestérasiques est décevante et le recours auximmunosuppresseurs est souvent nécessaire. Le pronostic est plus sévère mais l'évolution soustraitement est généralement favorable.


ID : 200417


TITLE : NEUROLOGIC MANIFESTATIONS OF ACUTE PORPHYRIAS: CASE REPORT ANDLITERATURE REVIEW

Author : Brahem Z [1] , Bedoui I [1] , Zaouali J [1] , Mansour M [1] , Riahi A [1] , Derbali H [1] , Messelmani M [1] , Mrissa R [1]


TOPIC : Other

ABSTRACT : INTRODUCTION:Porphyrias are rare disorders of heme metabolism,eachcharacterized by a defect in an enzyme required for thesynthesis of heme.They typically producesevereand acute abdominal pain in association with neuropsychiatricsymptoms. Neurologicalmanifestations are less common. CASE REPORT:An 18yearold girl was admitted to our hospital inDecember 2015. She presented acute weakness of her legs with an ascending motor deficit to armsassociated with sensory and autonomic symptomsover a week.She reported an acute abdominalpain, diarrheaand dark urine one week before weakness. She underwent anextensive workupincluding endoscopy, abdominalCT scanbut no abdominal cause was detected. No familyhistory ofsimilar symptomsis noted.Neurological examination showed flaccid tetraplegia with areflexia.Electrophysiological findings are consistent with motor axonal neuropathy. Measurement of porphyrinlevels in urine and blood was high. She received intravenoushematin with a daily dose of5 mg/kggiven for 14 days with goodclinical response. DISCUSSION:Most porphyrias have an autosomaldominant inheritance pattern with incomplete penetrance. Only acuteintermittent porphyrias causeneurological manifestations.The central and the peripheral nervous systemsare both affected byporphyria. Patients will often have a motorpredominant neuropathy with proximal and distalcomponents mimicking acute inflammatory demyelinatingpolyneuropathy. Autonomic involvementisalso seen.Several atypical manifestations have been described, including presentation with bilateralradial neuropathies, seizuresand subarachnoid hemorrhage. CONCLUSION:In front of acutepolyneuropathy, porphyrias should be evoked especially if associated with abdominal pain andpsychiatric symptoms


ID : 200418


TITLE : OCULAR MANIFESTATIONS OF SCEREBROVASCULAR DISEASES

Author : ben salem mariem [1] , Chebbi A [1] , Rouatbi A [1] , Korbi M [1] , Massmoudi E [1] , Zbiba W [1] , Bouguila H [1] , [1]

Affiliation : [1]Hedi Raies national institute of ophthalmology,Tunis, Tunisia. Departement “C


ABSTRACT : INTRODUCTION Neuroophthalmic emergencies are relatively uncommon, howevertheir outcome cause severe morbidity and even mortality. They may present with diplopia, visual loss,eye movement disorders and/or anisocoria as initial symptom. This entity includes severalneurovascular disorders such as monocular transient visual loss, Horner’s syndrome, cerebralthrombosis and acute ophtalmoplegia. Prompt diagnosis and immediate therapy are needed for thepatient's survival. The aim of this study is to focus on clinical features of those disorders in which theclinical outcome is dependent on timely and accurate diagnosis and management. METHODS Aretrospective study of patients who were presented to the ophtalmic emergency departement of HediRaies institute between June 2010 and July 2015 for a neuroophthalmologic emergency. Diagnosiswas based on complete ophtalmic and neurological examination and neuroimaging studies.RESULTS Twentyfive patients were enrolled. The median age was 37.5 years (20 to 55 years).There were 15 male and 10 female patients. Monocular transient visual loss was diagnosed in 4cases (16%), Horner’s syndrome in 3 cases (12%), cerebral thrombosis 7 cases (28%), acuteophtalmoplegia in 5 cases (20%), aneurysm of internal carotid artery in 3 cases and for 3 patientscarotid cavernous fistula . CONCLUSION The clinician should be aware of common neuroophthalmicemergencies including , monocular transient visual loss, Horner’s syndrome, cerebral thrombosis,acute ophtalmoplegia or oculomotor nerve palsies, and Horner syndrome related to carotiddissection. Prompt diagnosis and treatment of these conditions improve the possibility of favorableoutcomes.


ID : 200419


TITLE : ONCHOCERCIASISASSOCIATED NEURODEVELOPMENTAL DEFICITS: THE HIT SQUAD

Author : jean marie kashama [1] , Musasa H [1] , Kambaja B [1] , Bumoko M [1] , OkitunduD [1] , Bora K [2] , Nseka T [3] , Kunyu B [3] , Mwanza JC [4] , Mumba DN [5] , TshalaKatumbay D [6]

Affiliation : [1]1Department of Neurology, University of Kinshasa, Kinshasa, Dem. Rep. of Congo, [2]2Department of Neurology, University of Lubumbashi, Kinshasa, Dem. Rep. of Congo, [3]3Department of Clinical Biology, University of Kinshasa, Kinshasa, Dem. Rep. of Congo, [4]4Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NorthCarolina, USA ,5Department of Ophthalmology, University of Kinshasa, Kinshasa, Dem. Rep. ofCongo, [5]5Department of Ophthalmology, University of Kinshasa, Kinshasa, Dem. Rep. of Congo,3Department of Clinical Biology, University of Kinshasa, Kinshasa, Dem. Rep. of Congo, [6]6NationalInstitute of Biomedical Research, Kinshasa, Dem. Rep. of Congo ,1Department of Neurology,University of Kinshasa, Kinshasa, Dem. Rep. of Congo ,7Department of Neurology and School ofPublic Health, Oregon Health and Science University, Por


ABSTRACT : Background New challenges in neuroinfections arise as recent studies point out to apossible etiological role for onchocerciasis in epilepsy. Objective To elucidate the degree ofassociation between epilepsy associated neurodevelopmental deficits (ENDD) and onchocerciasisinCongolese children recruited from a community subjected to mass treatment with ivermectinApproach. A multidisciplinary team carried out studies using SMART (standardized monitoring andassessment of relief and transition) methodology for nutritional assessment andKABCII testingbatteries for cognitionin CongoKinshasa. Skin biopsies were used to confirm Onchocercainfection.Plasma cytokines were measured using the Human cytokine magnetic 30plex (Life Technologies,CA). Results Fiftyone and five percent of households were experiencing food insecurity with 59.5 %(54.3 – 64.5) of children with stunted growth. Of the 130 subjects from acasecontrol study, 91 (70%)[mean age (SD): 23.2 (8.4) years] reported having epileptic seizures. Logistic regression indicatedthat epilepsy was associated with onchocercias [OR: 4.42 (1.97 – 9.91), p < 0.01)] and family historyof epilepsy [OR: 5.72 (1.83 – 17.9), p < 0.01). Epilepsy was also associated with poor cognition in alldomains of memory, learning, and planning; and levels of growth factor EGF and IL8. Poor memorywas associated with early onset of epilepsy, stunting,and levels of growth factors and/or cytokinesnotably RANTES (ρ = 0.35, p = 0.01 with memory KABCII scores) or GCSF (ρ = 0.42, p = 0.04) inonchocerciasis subjects. Conclusion The pathogenesis of ENDD in onchocerciasisarea ismultifactorial. Neurocognitive deficits may be mediated by inflammation and/or chronic malnutrition.


ID : 200420


TITLE : PROGNOSTIC VALUE OF SERUM URIC ACID IN ACUTE STROKE PATIENTS AT THEDOUALA GENERAL HOSPITAL

Author : mapoure yacouba [1] , Ayeah MC [1] , Luma NH [1] , Njamnshi AK [1]

Affiliation : [1]Prognostic value of Serum Uric Acid in acute stroke patients at the Douala GeneralHospital


ABSTRACT : Background: Serum uric acid (SUA) is a neuroprotective agent but its prognosticsignificance in acute stroke still remains controversial. Objectives: Determine the prevalence ofhyperuricemia and its association with cerebrovascular risk factors (CVRFs), and outcomes of strokepatients in the Douala General Hospital. Methods: This was a retrospective cohort study whichincluded acute stroke patients with baseline SUA levels and 3 months post stroke followup data. SUAvalues were divided into quintiles. Associations between high SUA levels and stroke outcomes wereanalyzed using multiple logistic regression analysis. Results: A total of 701 acute stroke patients werereviewed and the prevalence of hyperuricemia was 58.8% with a mean SUA level of 68.625±24mg/l.Significant associations were observed between hyperuricemia and advanced age, male gender,atrial fibrillation, congestive heart failure, valvulopathy, previous stroke, decreased high densitylipoprotein cholesterol ,elevated diastolic pressure (p<0.05). Hyperuricemia were significantlyassociated with death after stroke with unadjusted odds ratio of 1.576 (CI: 1.0562.352; p=0.025)amongst acute stroke patients. Stroke mortality significantly increased across higher SUA quintiles inacute stroke patients (p=0.039). At month one, hyperuricemia was significantly associated with poorfunctional outcomes amongst patients [p<0.001, OR= 2.475 CI: 1.6553.703] while at month three,hyperuricemia was also significantly associated with poor functional outcomes amongst acute strokepatients [p=0.001, OR= 2.116 CI: 1.3493.320]. Hyperuricemia was neither an independent predictorof stroke death nor poor functional outcome. Conclusion: The prevalence of hyperuricemia in strokeis quite high and is associated with stroke mortality and adverse functional outcomes in acute stroke.Keywords: hyperuricemia, stroke, mortality, functional outcome.


ID : 200421


TITLE : QUALITÉ DE VIE DES ADULTES ATTEINTS D'ÉPILEPSIE DANS UN HÔPITAL DERÉFÉRENCE AU CAMEROUN

Author : HOTCHO CORINE [1] , SINI VICTOR [2] , KUATE TEGUEU CALIXTE [2] , NGUEFACKSERAPHIN [2] , NJAMNSHI ALFRED [2] , NJIENTCHEU VINCENT DE PAUL [2] , NGOUNGOURE H[3]

Affiliation : [1]Université d'Abomey Calavi/ Faculté de Médecine, CNHU Service de Neurologie/Cotonou, Bénin, [2]Université de Yaoundé 1/ Faculté de Médecine, , [3]Université Cheikh Anta Diop/Faculté de Médecine, CHNU FANN/ Service de neurologie, Dakar, Sénégal

TOPIC : Epilepsy

ABSTRACT : INTRODUCTION : L'objectif de cette étude était de déterminer la qualité de vie (QDV)des patients adultes atteints d'épilepsie. MÉTHODE Il s'agissait d'une étude transversale descriptiveallant de février à juillet 2013 au service de neurologie de l'Hôpital Central de Yaoundé. Tous patientsâgés d'au moins 18 ans avec une épilepsie active, suivis depuis au moins un an étaient inclus. Lescaractéristiques sociodémographiques et cliniques des patients étaient recueillies grâce à une fichetechnique. La QDV était évalué à l'aide de la « Quality of live in Epilepsy31 Inventory : QOLIE31 ».Un score inférieur à 50 correspondait à une mauvaise QDV. L'analyse statistique a été faite grâce aulogiciel SPSS version 17.0. Toute différence était significative pour une valeur de p<0,05. RÉSULTATS Au total, 82 patients ont été inclus. La moyenne d'âge était de 32,3±11,5 ans (extrêmes1865 ans) avec 51,2% d'hommes. La durée moyenne de l'épilepsie était de 9,3±9,1 ans (extrêmes148 ans). La moyenne du score total de QDV de nos patients était de 59,67±16,57. Un mauvaisscore de QDV était retrouvé chez 30,5% de nos patients. Le sous score correspondant à l'inquiétudepar rapport aux crises était le plus bas. Les facteurs influençant négativement la QDV étaient : lafréquence élevée des crises (P=0,02, IC=1,2412,56), la présence d'effets secondaires auxantiépileptiques (P=0,03, IC=1,057,63) et la présence d'un traitement traditionnel antérieur (P=0,01,IC=1,3414,46). CONCLUSION. La qualité de vie était médiocre chez 1/3 des patients. Un boncontrol des crises et l'éducation thérapeutique restent des facteurs essentiels pour une meilleureQDV des adultes atteints d'épilepsie.


ID : 200422


TITLE : RESTLESS LEGS SYNDROME AND PARKINSON DISEASE

Author : brahem zeineb [1] , Bedoui I [1] , J. Zaouali [1] , M. Mansour [1] , A. Riahi [1] , H. Derbali[1] , M.Messelmani [1] , R. Mrissa [1]



ABSTRACT : INTRODUTION:Sleep disorders are among the most common nonmotormanifestations in Parkinson's disease (PD) and have an immense negative impact on their quality oflife.The association between restless legs syndrome (RLS) and PD has been studied. CASEREPORT:Two patients, woman and man, aged 62 and 65 years old had presented with Numbness,tingling, burns, painful cold, electric shocks in legs only occurring during the night when resting in bedwith imperious need to move the lower limbs. Few months later, they developed asymmetric tremor intheir arms. Clinical examination showed an asymmetric parkinsonian syndrome.RLS was diagnosedusing the International RLS Study Group criteria. Patients didn’t have anemia. They receiveddopaminergic agonists with disappearance of RLS within 3 months. DISCUSSION:RLS is a disordercharacterized by an irresistible urge to move the legs during rest, usually accompanied byuncomfortable sensations in the affected extremities.Its prevalence estimates range from 0% to 52%in PD, but the causal relationship between the two disorders is still debated.The precisepathophysiology remains unknown, it isassumed that dopaminergic mechanisms play a centralrole.RLS in PD patients starts relatively late (after PD onset) but early onset is also Reported. RLSusually accompanies with psychiatric problems (depression, anxiety)which impact negatively thequality of life of these patients.Management of RLS usually starts with optimization of antiparkinsoniantherapy. CONCLUSION: Severe RLS may be an early feature of PD.RLS and PD can coexist,whether or not they share a commonpathophysiology


ID : 200423


TITLE : SYNDROME DES POINTESONDES CONTINUES DU SOMMEIL : 30PATIENTS COLLIGéSAU CHNU DE FANN

Author : BASSE Anna.M [1] , DIALLO I [1] , SOW A.D [1] , NDIAYE M [1] , DIAGNE N.S [1] , DIOPM.S [1] , GAYE N.M [1] , TOURE K [1] , DIOP A.G [1] , NDIAYE M.M [1]


TOPIC : Epilepsy

ABSTRACT : Introduction: Le syndrome des "Pointeondes Continues du Sommeil" (POCS) est uneencéphalopathie épileptique sévère de l’enfant. Cette étude vise à déterminer le profil des enfantsatteints de POCSdans une cohorte d'enfants sénégalais. Patients et méthodes: Il s’agissait d’uneétude prospective de dossiers d'enfants atteints d'encéphalopathie épileptique avec des POCSdeJuillet 2007 à Décembre 2016dans le service de neurologie du CHU de Fann. Résultats: Nous avonscolligé 30 patients, en majorité des garçons (60%). L’âge moyen était de 8,43 2,43 ans. Les crises lesplus fréquentes étaient généralisées tonicocloniques (17 enfants),partielles motrices (8 cas) etcomplexes (3 cas). L’examen clinique retrouvait un déficit cognitif global (6 cas), unehyperactivité (3cas), une régression physique et comportementale (7cas). L’électroencéphalogramme de veillemontrait un foyerfocaldans 12 cas et diffus dans 7 cas. L’enregistrement de sommeil montrait despointeondesoccupant plus de 85% de l’époque.Tous les patients étaient sous corticothérapieassociée au Valproate de sodium. Seuls 7 patients avaient un arrêt des crises avec disparition desanomalies électriques. Conclusion: Le pronostic de l'encéphalopathie épileptique avec des pointesondes continues du sommeil reste pauvre et entrave le développement neuropsychologiquesdesenfants. Motsclés: POCS, encéphalopathie épileptique, Sénégal


ID : 200424


TITLE : BALO'S CONCENTRIC SCLEROSIS

Author : AGIELA Mabroka [1]

Affiliation : [1]Department of medicine, neurology unit .


ABSTRACT : Background : It 's an MS variant in which there is pathological evidence of large lesionwith a concenttric pattern of alternating layers of preserved and destroyed myeline. Case report : A37 year old single libyan female presented with history of acute onset left side body weakness . therewas no significant past medical history . On examination cranial nerves intact , fundi was normal with pyramidal signs left side , motor power UL and LL limb grade 2/5. right side normal. MRI showenright hemispher big lesion layered as hyperintense rings altarnating with normal appearing whitematter. Patient recieved I.V1g Methylprednisolone for five days and improved . Discussion: Balo'sconcenteric sclerosis is most striking condition usually associated with acute, sever clinical evants, itsmore common in Chinese people, it may also present as an acute episode in a known case of moretypical MS. Balo lesion consist of multiple ring shaped areas composed of a destruction andpreservation of myline . The mainstay of treatment is high dose corticosteroid , plasme exchange issecond line in case of failure to improve and in refractory case , improvment has been reported withI.V immune globulin.


ID : 200425


TITLE : THE TEST OF SENEGAL: A VALID AND RELIABLE TOOL TO SCREEN FOR DEMENTIA INA SENEGALESE ELDERLY POPULATION

Author : Touré Kamadore [1] , Coumé Mamadou [2] , NdiayeNdongo Ndeye Dialé [3] , ThiamMamadou Habib [3] , Zunzunegui Maria Victoria [4] , Bacher Yves [5] , Basse Anna [6] , SowAdjaratou [6] , Seck Lala [6] , Ndiaye Moustapha [6] , Diop Amadou Gallo [6] , NdiayeMouhamadou Mansour [6]

Affiliation : [1]1 Department of Health Sciences, University of Thies, Senegal ,2 Department ofNeurology, Fann University Teaching Hospital, DakarSenegal, [2]3 Department of Internal Medicine,HALD University Teaching Hospital, DakarSenegal, [3]4 Department of Psychiatry, Fann UniversityTeaching Hospital, DakarSenegal, [4]5 Department of Social and Preventive Medicine, Faculty ofMedicine, University of Montreal, QuébecCanada, [5]6 Memory Clinic, Division of Geriatric, JewishGeneral Hospital, Sir Mortimer B Davis, Faculty of Medicine, University McGill, Montréal, QuébecCanada, [6]2 Department of Neurology, Fann University Teaching Hospital, DakarSenegal


ABSTRACT : Summary Background. Dementia is a public health priority worldwide with an impact inthe social economic and health system. However, it is underdiagnosed. Existing screening tools arebiased by level of education. This is the reason why we develop the Test of Senegal. Objective. Tovalidate the "Test of Senegal" as a screening tool for dementia in Senegalese elderly population.Methodology: The "Test of Senegal", developed by Kamadore Touré, is a tool with items onorientation, memory, attention, praxis and language for a score of 039 points. It was applied toSenegalese elderly patients aged 55 years and plus utilizing the Health and Social Center of IPRES(Institution de Prévoyance Retraite du Sénégal), DakarSenegal for health care through a two steps:1) a crosssectional study among 872 patients to identify the cases of dementia using the DSM IVRcriteria; 2) a casecontrol study with 58 cases of dementia and 58 control of the same sex for thevalidation of the tool. The "Test of Senegal" was administered at the first step and readministeredblindly 1 and 2 weeks later at the second step. Criterion validity, construct validity and reliability of thetool were evaluated. The confounding effect of age and education on the tool was assessed bylogistic regression analysis. Results. The "Test of Senegal" identified dementia at the best cutoffpoint of 28/39 with the following criteria: sensitivity (93.1%), specificity (89.6%), positive predictivevalue (93.1%), negative predictive value (92.8%). The area under the ROC curve was 0.967. Kappacoefficient was 0.82. The intraclass correlation coefficients varied between 0.67 and 0.87. Age andeducation had no confounding effect. Conclusion. The "Test of Senegal" is a simple, valid and reliabletool to assess for dementia in a Senegalese elderly population useful as a screening tool in healthcare settings. Keywords. Dementia; Screening tool; Neuropsychological Testing; Senegal


ID : 200426


TITLE : CAUSES DETERMINED TO SUBJECT YOUNG CEREBRAL INFARCTION

Author : benabadji souad [1] , S.ALLAL [1] , S.MERINI [1] , M.SAADA [1] , C.DALIYOUCEF [1] , ZEKRI [1] , D.BOUCHENAK KHELLADI [1]

Affiliation : [1] Departement of Neurology University –Tlemcen ( ALGERIA)


ABSTRACT : INTRODUCTION: Ischemic stroke in young subjects are a diagnostic challenge for theclinician, despite the achievement of comprehensive reports, a large proportion of these cerebralinfarction remains of unknown cause. OBJECTIFS: Determine the etiological characteristicsdetermined causes of cerebral infarction in young subjects in CHU Tlemcen, with TOASTclassification (trial of org 101 72 in acute stroke treatement) PATIENTS AND METHODS: Weconducted a descriptive prospective study to longitudinal collection of the ischemic brain of youngsubjects aged 15 to 45 years, from January 2012 to June 2014 at the CHU Tlemcen. We followed therecommendations of the French of Neuro vascular (SFNV) society. RESULTS: 168 patients havebeen recorded during this period, we have noted predominance female with a sex ratio to 0.73, 4045years old age group was majoritaire.24, 4% of our patients had a cause determined according to theTOAST. Carotid dissections are level 1 (6.5%), followed by the Angiopathies of postpartum (5.4%),the APS (anti Phospholipid antibody syndrome) 4.8%, 03 case of NeuroBehcet, 02 Neurolupus, 02cases of Takayasu. DISCUSSION: Our clinical outcomes, closer to literature, there is a great diversityin the etiologies of the AIC of the young subject compared with the elderly. The non availability ofsome assessments of radiological and immunological explorations at the level of our CHU and theircost has been a barrier. Carotid dissection is still the main cause of AIC in young subjects, but she stillunderestimated in our study because in European studies, it varies between 516%. CONCLUSION:The stroke did not spare the young subject, these different infarction of the elderly by their multipleetiologies, hence the search relentless to the etiology.


ID : 200428


TITLE : MIGRAINE ET QUALITé DE VIE EN MILIEU SCOLAIRE DANS UN LYCéE DU DISTRICT DEBAMAKO AU MALI

Author : DialloSH [1] , Maiga Y [1] , Koné M [1] , Sissoko M [1] , Diallo S [1] , Camara M [1] , Saliou M [1] , Y Sogoba [1] , Coulibaly D [1]

Affiliation : [1]CHU Gabriel Toure

TOPIC : Other

ABSTRACT : Migraine et qualité de vie en milieu scolaire dans un lycée du district de Bamako auMALI DialloSH*, Maiga Y, Koné M, Sissoko M, Diallo S, Camara M, Saliou M, Y Sogoba, Coulibaly D.I. Introduction La migraine constitue par son caractère invalidant et sa prévalence chez le sujet jeuneun réel problème de santé publique dans le monde. II. Objectifs Etudier les aspects épidémiologiqueset l’impact de la migraine en milieu scolaire dans un lycée district de Bamako au Mali. III. Méthodes Ils’agit d’une étude transversale comparative de 3 semaines portant sur 1120 élèves d’un lycée dudistrict de Bamako. Ils avaient un âge de 13 à 23 ans et étaient repartis en 3 strates parmi 1157élèves qui représentaient l’effectif du lycée. Les critères IHS 2004 nous ont servi de référentiel dansla classification de la migraine. IV. Résultats 652 étaient céphalalgiques dont 239 migraineux soit uneprévalence à 20,6%. Le sexe ratio était de 1,72. 92,9 % des élèves avaient 1 à 14 crises par mois. Ladouleur était unilatérale chez 86,6%; pulsatile chez 93,3%; intense chez 64,9%; exacerbée par lesactivités physiques chez 82,4 % ; avec des vomissements ou nausées chez 17,99% ; laphotophonobie chez 53,56%. 91,2% des élèves migraineux avaient connu un absentéisme de 1 à 14jours pendant le dernier mois. V. Discussion La prévalence de la migraine était de 20,6%. Il existeune prédominance féminine Les caractéristiques cliniques comparées aux études portant sur laqualité de vie du migraineux nous montre que, 92,9% des migraineux ont eu entre 1 à 14 crises aucours du dernier trimestre et une limitation de concentration à suivre les cours chez 57,7%. VI.Conclusion La prévalence de la migraine reste élevée en milieu scolaire, elle est invalidante etconstitue un réel handicap en milieu scolaire


ID : 200431


TITLE : RASMUSSEN SYNDROME LATE ONSET ABOUT 2 CASES

Author : abderrahmane ziari [1] , assia boulefkhad [2]

Affiliation : [1]constantine, [2]doctor

TOPIC : Epilepsy

ABSTRACT : Introduction : Rasmussen's syndrome is an inflammatory disease with chronic evolutionand probably autoimmune origin, characterized by drugresistant epilepsy, loss of movement , speechand mental deterioration witch appears in child. Observation : We report 2 cases of 2 righthandedadolescents aged 13 and 15 respectively, who presented partial motor seizures of the right hemibodyprogressively worsening to become multidaily. The neurological examination showed : a righthemiparesis for the first case. Right hemiparesis, aphasia of expression and painful dystonia of theright hand for the second case. EEG showed a burst of slow waves on the left side. Cerebral MRI hasobjectified extended hypersignals at the beginning and then atrophy of the left hemisphere. Thecombination of 3 antiepileptics with oral highdose corticosteroids has reduced the frequency ofseizures and improved motor deficit. Discussion : The incidence of lateonset form remains low (37cases) The clinical presentation as well as the evolutionary profile appear different than thoseobserved in infantile forms. Conclusion : RS usually affects the child but may occur in adolescenceand adulthood. Early introduction of corticosteroid therapy for late forms appears to be more effectivethan early forms.


ID : 200439


TITLE : DETERMINANTS OF OPTIC NEUROPATHY IN A COMMUNITY HYPERENDEMIC FORONCHOCERCIASIS AND EPILEPSY

Author : jeanmariekashama [1] , Bora K [1] , Nsambayi DL [1] , Lufundusu AM [2] , kunyu D [2] , Okitundu D [2] , Mwanza JC [2] , Mumba DN [2] , Tshala Katumbay [2]

Affiliation : [1]Department of Neurology , University kinshasa,Dem ,Rep of Congo, [2]


ABSTRACT : DETERMINANTS OF OPTIC NEUROPATHY IN A COMMUNITY HYPERENDEMIC FORONCHOCERCIASIS AND EPILEPSY 1Kashama JM, 2Bora K,3Nsambayi DL, 3Lufundusu AM,5Kunyu B, 1Okitundu D, 3,4Mwanza JC,5,6Mumba DN,1,6,7TshalaKatumbay D. 1Department ofNeurology, University of Kinshasa, Kinshasa, Dem. Rep. of Congo 2Department of Neurology,University of Lubumbashi, Kinshasa, Dem. Rep. of Congo 3Department of Ophthalmology, Universityof Kinshasa, Kinshasa, Dem. Rep. of Congo 4Department of Ophthalmology, University of NorthCarolina at Chapel Hill, Chapel Hill, North Carolina, USA 5Department of Clinical Biology, University ofKinshasa, Kinshasa, Dem. Rep. of Congo 6National Institute of Biomedical Research, Kinshasa, Dem.Rep. of Congo 7Department of Neurology and School of Public Health, Oregon Health and ScienceUniversity, Portland, Oregon, USA Purpose:Determine whether ophthalmological findings predict riskfor epilepsy in onchocerciasisendemic areassubjected to mass distribution of ivermectin.Methods:Sixtysixepileptic cases and 23 controlsunderwent standard ophthalmological assessments,scanning laser polarimetry (SLP) around the optic nerve head, and skin biopsy for Onchocercavolvulus detection. Results:A diagnosis of optic neuropathyconfirmed through SLP was made in 16subjects (18%). Univariable analysis showed a significant association (1sided Fischer’s exact test)between abnormal SLPand positive biopsy (p = 0.03), epilepsy (p= 0.06), and treatment withivermectin (p = 0.08). There was a significant correlation (Spearman) between thickness of the retinanerve fiber layer (RNFL),proinflammatory (IL12: ρ = 0.25, p = 0.032; RANTES: ρ = 0.29, p = 0.013;MIP1a: ρ =0.26, p = 0.026; IFNɣ: ρ = 0.209, p = 0.014; TNF α: ρ = 0.25, p = 0.031; IL7: ρ = 0.30,p = 0.01), and some antiinflammatory cytokines (GCSF: ρ = 0.24, p = 0.031; IL13: ρ = 0.24, p =0.042; INFα: ρ = 0.26, p = 0.025; IL1RA: ρ = 0.25, p = 0.036). Multiple logistic regression revealedthat subjects who received ivermectin were 8.9 times more likely to exhibit an abnormal SLP (p =0.036). Those with a positive skin biopsy also tended to exhibit thinning of the RNFL (p = 0.055).Conclusions:Optic neuropathy may not predict risk for epilepsy in onchocerciasisendemic areas.However, studies are needed to determine the ivermectinattributable risk in relation to opticneuropathy.


ID : 200444


TITLE : CLINICAL AND ELECTROPHYSIOLOGICAL ASPECTS OF DIABETIC NEUROPATHIES:STUDY OF 57 CASES

Author : Fatimata Hassane DJIBO [1] , BIROUK Nazha [2] , ERRGUIG Leila [2] , Kably Bouchra [2] , BELAIDI Halima [2] , OUAZZANI Reda [2]

Affiliation : [1]Neurolophysiology,CHU IBN SINA,Rabat,Morroco, [2]Neurophysiology ,CHU INBSINA,Rabat,Morroco


ABSTRACT : Introduction Neuropathies are the most common complication of diabetes. Ourobjective is to evaluate the clinical and electrophysiological aspects in 57 patients. Patientsmethods:We retrospectively collated the cases of diabetic neuropathies addressed for ENMG, fromJanuary 2015 to January 2016 in the clinical neurophysiology department of the Ibn Sina UniversityHospital in Rabat. Outcome These were 43 women and 14 men aged 2780. The average timebetween diagnosis of diabetes and neurological involvement was 16 years. Clinical signs includedneuropathic pain in the form of numbness, tingling and limb weakness. Thirtyseven cases ofpolyneuropathies were diagnosed, 11 of which were isolated, 19 associated with carpal tunnelsyndrome, 6 associated with root canal involvement, and 1 with facial nerve damage. Sixteen patientshad isolated carpal tunnel syndrome, three had isolated root canal involvement, and one patient hadroot canal nerve injury. Sensory affections predominated in 46 cases, or 80.70% versus 11 cases or19.29% sensitivomotor involvement. Discussion and conclusion: Substantially sensitive axonalpolyneuropathies were predominantly sensitive, followed by ductal involvement followed by rootdamage. These patterns should be correlated with the age of diabetes and the existence of other riskfactors and other degenerative complications of diabetes.


ID : 200452


TITLE : LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH PARKINSON’S DISEASE:FINDINGS FROM A TUNISIAN COHORT

Author : ACHOUR Khaoula [1] , KACEM Imen [1] , MRABET Saloua [1] , NASRI Amira [1] , SIDHOM Youssef [1] , GARGOURI Amina [1] , BEN DJEBARA Mouna [1] , GOUIDER Riadh [1]

Affiliation : [1]Department of Neurology , UR 12SP21, Razi Hospital, Tunisia


ABSTRACT : Background Prevalence of LUTS in PD varies widely (2771%) according to studies’methodology. The assessment of their impact on QoL with validated questionnaires has beenperformed seldom. Objective To assess lower urinary tract symptoms (LUTS) in patients withParkinson’s disease (PD) and to investigate their impact on the quality of Life (QoL). Methods Weprospectively assessed 32 patients with PD (16 men and 16 women), at the Neurology department ofRazi Hospital. Autonomic symptoms were evaluated by SCOPAAUT. LUTS and their impact on QoLwere assessed by International Prostate Symptom Score (IPSS). QoL was assessed with Qualiveenshort form score (SFQualiveen). Results Mean age and duration of the disease were respectively64.34 and 13.3 years. At least one LUTS was reported by 29 patients (90%). Mean IPSS was 4,22.Nocturia was the most prevalent symptom, affecting 90% of patients, followed by urgency (84%),incontinence (75%) and pollakiuria (69%). There was no significant difference in urinary symptomsaccording to gender. In men, 15/16 had erectile dysfunction. Mean SCOPAAUT score was 16 with nosignificant difference according to sex. Mean SFQualiveen score was 1,23. Only incontinence wassignificantly associated with worse SFQualiveen score (p=0,035). Conclusions: Our study showedthe high frequency and severity of urinary symptoms in patients with PD, independently from gender.Incontinence seems to be the main type of LUTS affecting QoL, and it is probably due to autonomicdysfunction especially in advanced stages of PD.


ID : 200454


TITLE : SPECTRUM OF AUTOIMMUNE DEMENTIAS: FINDINGS FROM A TUNISIAN COHORT

Author : BEN DJEBARA Mouna [1] , KACEM Imen [1] , MARABET Saloua [1] , SIDHOM Youssef [1], NASRI Amira [1] , JERIDI Cyrine [1] , GARGOURI Amina [1] , GOUIDER Riadh [1]

Affiliation : [1]Department of Neurology, UR 12SP21, Razi Hospital, Tunisia


ABSTRACT : Introduction Autoimmune dementias (AID) are acquired and potentially treatablecauses of dementia are rare and often under recognized. Objectives Describe the clinical andparaclinical features of AID. Methods Retrospective study of 14years(20032016) including patients,followed in the Department of Neurology of Razi Hospital, who have dementia according to the DSMV criteria, revealing or complicating an autoimmune disease. All patients had brain imaging andimmunological assessment. We analyzed clinical and neuropsychological features were analyzed.Results We collected 17 patients (sexratio:0,29; mea nage of onset of dementia:59years; meanMMSE =18; mean BREF=7,9). Dementia revealed the autoimmune disease in 9 cases(lupus, mixedconnective tissue disease, Hashimoto encephalopathy (HE) et limbic encephalitis (LE)) orcomplicating the course of the disease in 8cases(multiple sclerosis (MS), Behçet’s (BD), Horton(HD)disease et GougerotJörgen syndrome(GSS)). Five patients had memory troubles with hippocampalprofile and 15cases had executive disorders. Brain imaging showed vascular(n=6) andinflammatory(n=10) lesions and atrophy(n=14). Discussion The female predominance and theyounger age of onset found in our cohort are in accordance with literature. The pathophysiology ofAID is dominated by white matter and vascular lesions found in the majority of our patients. AID oftencomplicate the course of the disease in GSS and BD, rarely in MS found in 3 of our patients.Conclusion Our cohort illustrates the rarity of AID dominated by GSS, their younger age of onset andthe predominance of the frontal subcortical cognitive profile.


ID : 200456


TITLE : SPECTRUM OF NONMOTOR SYMPTOMS IN ESSENTIAL TREMOR IN A TUNISIANPOPULATION

Author : SAGUEM Bochra [1] , NASRI Amira [1] , SIDHOM Youssef [1] , I. KACEM [1] , GARGOURIAmina [1] , M. BEN DJEBARA [1] , R. GOUIDER [1]



ABSTRACT : Background: Several studies have recently lighted out the importance of NMS in ET.These symptoms still, however, underrecognized. Objective: To assess non motor symptoms (NMS)in essential tremor (ET) patients in a Tunisian cohort. Methods: A crosssectional study in theDepartment of Neurology at Razi University Hospital in Tunisia (OctoberDecember 2016) includingconsecutive patients with ET. The FahnTolosaMarin Tremor Rating Scale (TRS) and the previouslyvalidated Arabic version of NonMotor Symptoms Scale (NMSS) were used to assess respectivelymotor and non motor symptoms. Results: We included 31patients (mean age=71,35years, mean ageof tremor onset=62 years, mean duration of tremor=9,30years, mean TRS score=36,68). All thepatients reported NMS with NMSS mean score of 69,35. These NMS were mild in 19,4% of patients,moderate in 9,7%, severe in 19,4% and very severe in 51,6%. Urinary, attention/memory,sleep/fatigue and mood/cognition problems were the most severe nonmotor symptoms in ourpopulation, with mean scores of 36.10, 35.39, 29.16 and 22.75 respectively. Perceptual problemswere the less severe symptoms, with a mean score of 0,98. The motor total score was correlated tothe age of participants(p=0,002); but not to the age at onset of tremor(p=0,09). NMSS total score wasnot correlated neither to age(p=0,28), age at onset tremor(p=0,21) nor to the motor totalscore(p=0,24). Conclusion: NMS were constant in our cohort, very severe in more than half of thepatients, and not correlated to motor signs. These findings may denote a peculiar phenotype of ET inour population, needing further genetic investigations to be confirmed.


ID : 200457


TITLE : DOES HYPOXIA CAUSE CARPAL TUNNEL SYNDROME? A STUDY OF 28 CASES

Author : JARDAK Fedia [1] , GARGOURI Amina [1] , KACEM Imen [1] , N. Kessentini [1] , SIDHOMYoussef [1] , NASRI Amira [1] , BEN DJEBARA Mouna [1]


TOPIC : Other

ABSTRACT : Introduction : Carpal tunnel syndrome (CTS) is a frequent neuropathy. One possibleetiological reason for the increased susceptibility of median nerve compression is changes in themicrovascular structure of the nerve which could lead to hypoxia. Purpose: The aims of our studywere to emphasize on the correlation between the severity of CTS and oxygen saturation as anhypoxia indicator. Methods: We prospectively evaluated 28 patients in the electroneuromyographyunit of the department of Neurology in Razi hospital in Tunis, Tunisia, during the period between the1st and 15 January 201. Inclusion criteria was the presence of carpal tunnel confirmed byelectrodiagnosis. We evaluated oxygen saturation in all patients. Results: At the moment of the study,11 patients presented with severe pain in wrist and fingers. Oxygen saturation in this group variedfrom 94 to 99.75 with an average of 97.20±1.7. In other patients, it varied from 94.5 to 99.25 with anaverage of 97.33±1.3. Statistical analysis showed no significant difference in oxygen saturationbetween the two groups: p= 0.415. Discussion and conclusions : One possible etiological reason forthe increased susceptibility of median nerve compression is hypoxia. In our study, we did not find astatistically significant differences in oxygen saturation between patients who had severe clinical CTSsymptoms and those who were not in pain at the moment of the evaluation. This result may not besufficient to conclude that CTS physiopathology does not include microvascular changes in mediannerve. More sophisticated measures could lead to better results.


ID : 200458


TITLE : ELECTROENCEPHALOGRAPHY IN JUVENILE MYOCLONIC EPILEPSY (JME)

Author : KACEM Imen [1] , MRABET Saloua [1] , I. ABDELKEFI [1] , SIDHOM Youssef [1] , NASRIAmira [1] , GARGOURI Amina [1] , GOUIDER Riadh [1]


TOPIC : Epilepsy

ABSTRACT : Introduction JME is the most common type of idiopathic generalized epilepsy (IGE)accounting for 26.7% of IGE and 4.1% of all epilepsies. The EEG shows typically 46 Hz spike wavesor polyspike waves. Nonspecific or misleading features such as focal changes are found resulting inmisdiagnosis. Aim : To describe the EEG abnormalities found in JME patients. Methods : Data frompatients with JME examined in the neurology department of Razi Hospital between 2003 and 2015were analysed retrospectively. All patients had welldocumented diagnoses of JME. EEG wereperformed using 10/20 system with 21 electrodes. We obtained conventional EEG recordings alongwith activating methods. Results : We included 100 patients (58 women52 men), all had normalbackground activity. EEG was normal in 39 patients (35.45%), generalised interictal abnormalitieswere found in 27.27%, generalised abnormalities with focal maximum were seen in 28.18%, focaldischarges were seen in 9.09%. Amplification with hyperventilation and photosensitivity were found in30% and 20.9% respectively. Discussion : Our findings are consistent with data of litterature. In fact,many JME patients may present a normal EEG pointing out the fact that a normal EEG does notexclude the diagnosis. Focal discharges may also be found among patients with JME, leading to anerroneous diagnosis of focal epilepsy. Conclusion : We conclude that focal interictal discharges inJME are common in JME. Those findings must be known to avoid a wrong diagnosis of the type ofepilepsy and aggravating treatment.


ID : 200459


TITLE : PARTICULARITY OF CHRONIC INFLAMMATORY DEMYELINATINGPOLYRADICULONEUROPATHY PATIENTS WITH DIABETES

Author : KESSENTINI Nehed [1] , KACEM Imen [1] , MRABET Saloua [1] , SIDHOM Youssef [1] , BEN DJEBARA Mouna [1] , GARGOURI Amina [1] , GOUIDER Riadh [1]



ABSTRACT : Introduction: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is anacquired demyelinating neuropathy. Several diseases have been associated with CIDP, includingdiabetes mellitus (DS). Objective: Study the clinical and electrophysiological characteristics of theCIDP with DS Methods: It’s a retrospective study including all patients with CIDP defined according tothe EFNS 2010 criteria associated with DS. In order to compare the result, we collected 22 patientswith diabetic polyneuropathy (PND). The clinical and paraclinical data were collected. Results: Werecruited 16 patients with CIDP DS. The mean age of consultation was 54 years versus 60 years inPND. The sex ratio was 3 versus 2.6 in PND. The mean duration of diabetic disease was 5 yearsversus 15 in PND. The most sign revealing was motor versus sensory in PND. The deficit moteur wasdistal in 8 patients tipping the upper and lower limbs in CIDP DS. It was distal and affecting only thelower limbs in PND. EMG showed demyelinating sensorymotor polyneuropathy with multifocalconduction blocks and Fwave latency increased in all patients, associated axonal involvement wasobserved in 4 patients. Conclusion: there is no significant difference in age and gender distributionbetween the two groups. Patients with PND were complained of imbalance on diabetes. CIDP mayfirst involve the upper extremities, unlike PND. In the CIDP, motor impairment is predominantlyproximal not found in our study. In EMG, the additive effects of diabetic axonal damage toconventional CIDP may make diagnosis more difficult.


ID : 200460


TITLE : QUALITY OF LIFE AND ITS DETERMINANTS IN ESSENTIAL TREMOR IN A TUNISIANCOHORT

Author : KACEM Imen [1] , NASRI Amira [1] , SAGUEM Bochra [1] , SIDHOM Youssef [1] , GARGOURI Amina [1] , BEN DJEBARA Mouna [1] , GOUIDER Riadh [1]



ABSTRACT : Background: Studies with regards to quality of life (QoL) and its determinants inpatients with essential tremor (ET), the commonest movement disorder, remain sparse. Objectives:To evaluate the QoL of patients with ET and the possible impact of motor(MS) and non motorsymptoms(NMS). Methods: A crosssectional study in the Department of Neurology at Razi UniversityHospital in Tunisia (OctoberDecember 2016) including consecutive patients with ET. QoL wasevaluated with the SF36 Quality of Life scale and the Quality of Life in Essential TremorQuestionnaire(QUEST). The FahnTolosaMarin Tremor Rating Scale(TRS) and the previouslyvalidated Arabic version of NonMotor Symptoms Scale(NMSS) were used to assess respectivelymotor and non motor symptoms. Results: We collected 31 patients (sexratio=0,72; mean age:71,35years; mean duration of the disease: 9,3 years; mean total motor score: 40,31; mean total NMSSscore: 67,96). All the patients had NMS, severe in 55,6%. QoL was altered in 73,1% of patients(mean total SF36 score=51,82, mean total QUEST score=25,37). Total SF36 score and the QUESTscore were correlated to the total motor score (p=0,019 and p=0,033), but only the QUEST score wascorrelated to the total NMSS score (p=0,043). Conclusion: Both MS and NMS were determinants ofQoL in our study. The frequency of NMS, constant in our patients, illustrates the intrinsic character ofthese aspects, long considered as secondary effect of MS. Our results emphasized the majorimplication of NMS in the alteration of the QoL, to be taken into consideration in the management ofET.


ID : 200461


TITLE : THE USEFULNESS OF VIDEOELECTROENCEPHALOGRAPHY IN PSYCHOGENIC NONEPILEPTIC SEIZURES: A STUDY OF 42 CASES

Author : JARDAK Fedia [1] , GARGOURI Amina [1] , ABDELKEFI Istabrak [1] , KACEM Imen [1] , SIDHOM Youssef [1] , NASRI Amira [1] , BEN DJEBARA Mouna [1] , GOUIDER Riadh [1]


TOPIC : Epilepsy

ABSTRACT : Introduction : Psychogenic non epileptic seizures (PNES) are a common somatoformdisorder which diagnosis can be challenging. Purpose: The aims of our study were to emphasize onthe usefulness of VEEG in PNES diagnosis, to describe the main ictal symptoms, and to discuss theirdiagnostic and therapeutic impact. Methods: We underwent a retrospective study based on thedatabase of VEEG in the epilepsy unit of the department of Neurology in Razi hospital in Tunis,Tunisia, during the period between January 2010 and December 2016. Inclusion criterion was therecording of a PNES. Results: We included 42 patients. Seven patients (16.66%) were alreadydiagnosed with documented epilepsy. VEEG was indicated for suspected epilepsy in 21 cases andsuspected PNES in 6 cases. Episodes were associated with motor manifestations in 24 cases.Association of motor and affective phenomena was recorded in 7 cases, and consciousnessimpairment in 3 patients. Episodes duration varied from 2 seconds to 10minutes. Discussion andconclusions : VEEG monitoring yields to a higher level of confidence in establishing the diagnosis ofPNES. During the recordings, paroxysmal events may be typical of PNES (16 patients in our series)or less typical. PNES duration is longer than epileptic seizures (ES). Our study showed that 16.66% ofpatients with PNES have coexisting ES, which is correlated with other studies (10–30%). Thediagnosis of associated PNES in epileptic patients may be helpful in evaluating seizures’ control. Italso helps avoiding treatment changes and the false diagnosis of drug resistant epilepsy.


ID : 200466


TITLE : IMPACT SCOLAIRE DE L’EPILEPSIE CHEZ LES ENFANTS

Author : Noel ZODALY [1] , RAKOTONDRAMANANA A [2] , LEMAHAFAKA G [2] , TEHINDRAZANARIVELO A.D [2]

Affiliation : [1]USER de NEUROLOGIE de L’HUJRB Antananarivo Madagascar , [2]

TOPIC : Epilepsy

ABSTRACT : Introduction : L’épilepsie peut entraver le développement cognitif de l’enfant et pouvantainsi entrainer une difficulté scolaire. A Madagascar, aucune étude n’est publiée concernant cethème. Ainsi, nous l’avons choisi pour étudier le cas de notre pays. Nos objectifs sont la mise enévidence et l’estimation des liens entre l’épilepsie et les difficultés scolaires. Méthodes : Il s’agit d’uneétude prospective, transversale descriptive et analytique de type cas témoin réalisée au laboratoirede Neurosciences Santé Mentale Antsakaviro pour les cas dans quatre EPP de la communeruraleAnjepy pour les témoins, allant du 1er octobre 2014 au 31 janvier 2015. O n a évalué lafréquence de difficulté scolaire chez les enfants épileptiques, les relations entre les caractéristiquesde l’épilepsie et difficultés et les types de difficultés scolaires observés. Résultats : La fréquence dedifficulté scolaire chez les enfants épileptiques était de 49,13% contre 25% chez les non épileptiquesdont l’Odds ratio est de 2,90 avec un intervalle de confiance de 1,87 à 4,43, avec 52,94% des enfantsavaient leur première crises avant l’âge de 2ans dont les crises généralisées tonicocloniquesprédominent avec un taux de 57,65%. L’épilepsie idiopathique représentait les 67,06% des cas. Lamajorité des enfants présentaient le manque de concentration (43,53%) et le trouble de mémoire(31,76%). Conclusion : L’épilepsie est une maladie grave pour les enfants et pouvant entrainer detrouble d’apprentissage. De ce fait, la prévention de la survenue de crises ainsi le dépistage précocesont indispensables Mots clés : difficulté scolaire, épilepsie de l’enfants, manque de concentration,trouble de mémoire.


ID : 200475


TITLE : DEMENTIA IN SYNUCLEINOPATHIES: FINDINGS FROM A TUNISIAN COHORT OF 174PATIENTS

Author : Amira Nasri [1] , M. Ben Djebara [1] , Imen Kacem [1] , Y. Sidhom [1] , A. Gargour [1] , Riadh Gouider [1]



ABSTRACT : Background Parkinson’s Disease(PD), dementia with Lewy Bodies(DLB) and multiplesystem atrophy(MSA) are collectively known as synucleinopathies. Little is known on their cognitiveprofile differences. Objectives To describe the similarities and differences of the cognitive profile ofdementia syndromes in synucleinopathies. Patients and methods A 14 years retrospective study(20022016) including all the patients diagnosed with PD, DLB and MSA according to their respectiveconsensual diagnostic criteria, and having dementia according to DSM V criteria. Demographic,clinical and neuropsychological features were analyzed. Results We included 174 patients: 128 DLB,42 PD dementia(PDD) and 4 MSA. Age of onset of parkinsonism and age of onset of dementia wererespectively 72/73,5years in DLB, 65,9/75,1years in PDD and 50,5/53years in MSA. Hallucinationsand RBD were noted respectively in 92%/17% in DLB, 71%/36% in PDD and 25%/0% in MSA. Allpatients had memory disorders with mean MMSE at 13 in DLB, 17 in PDD and 22 in MSA. Ahippocampal profile was noted in 46% in DLB, 24,8% PDD and 25% MSA. Executive dysfunction wasmore marked in DLB and PDD(97%) in both than in MSA (75%), while apraxia was more frequent inDLB(90%) and MSA(50%) than PDD(36%). Conclusions In our series, DLB was the main cause ofdementia in synucleinopathies. The age of onset of dementia was similar in DLB and PDD, butyounger in MSA. Hallucinations were more marked in DLB, lesser in PDD, whereas RBD were morecommon in PDD. Dementia was more advanced in DLB with a more common hippocampal profile.


ID : 200477


TITLE : EARLY ONSET PARKINSON’S DISEASE : FEATURES, SYMPTOMS AND OUTCOME

Author : Mustapha Benmahdjoub [1] , M.Arezki [1]

Affiliation : [1]


ABSTRACT : Background Early onset parkinson’s disease is uncommon in people younger thanforty. It is also different from classical form by its clinical and pathological presentations. Objectives:the aims of this study was to determine epidemiological and clinical features and to evaluate outcomein patients with early onset parkinson’s disease. Methods : Data were collected prospectively from allpatients with clinical symptoms of parkinson disease during a eight years periode (2006 2013). Thestudy was conducted at the department of neurology at Blida university hospital. Results : 488parkinson’s disease patients were included in the study , Of these 43 had an early onset of thedisease with a mean age of 33.44 (2040). Inaugural dystonia (posture and lower limb) in 21%Symptoms of early onset Parkinson’s disease are often the same of common forme (53 ,48%).Genetic factors appears to play an important role in the onset of Parkinson's disease in Algeria due tothe high percentage of marriage among relatives. Outcome : The quality of response to Ldopa wassignificant with P <106 (mean motor score in OFF = 33.12 ± 9.55, the mean motor score in ON =12.70 ± 4.14), the mean disease duration was 12.34 ± 8.839 (extremes: 1 to 32 years) and theabsence of cognitive impairment, fluctuations and early onset dyskinesia had an impact on quality oflife . Conclusion: Early onset Parkinson’s is a serious chronic disease. Medications and lifestylechanges often relieve symptoms. They may also slow the disease’s progression.


ID : 200479


TITLE : IMPLICATION OF INSULAR SEIZURES DURING TEMPORAL SEIZURES: DISCUSSION OFTWO CASES.

Author : HASSANE DJIBO Fatimata [1] , LAHJOUJI Fatiha [1] , SMIL Lamiya [1] , Leila ERGUIG [1], Reda OUAZZANI [1]

Affiliation : [1]Service de neurophysiologie clinique du CHU Ibn Sina de Rabat.

TOPIC : Epilepsy

ABSTRACT : Introduction: Insular epilepsy has long been unknown because of the anatomicallocalization of the insula. The involvement of the insula in complex focal seizures remains poorlyelucidated and may decrease the chances of good postoperative outcomes in refractory epilepsies.Our aim was to investigate the clinical features that lead to the involvement of the insula in a case ofpharmacoresistant surgical temporal seizures. Materials and methods: We discussed two patientsreferred for refractory seizures in the clinical neurophysiology department of the Ibn Sina Hospital ofRabat for a presurgical evaluation.. Results: Our findings concerned two patients recorded in videoEEG in the presurgical evaluation. Both have presented temporoinsular seizures characterized bysomatosensory , visceromotor and viscerosensory clinical manifestations . MRI showed unilateralhippocampal sclerosis in one case and bilateral hippocampal sclerosis in the other case. Discussion:Our discussion will focus on the involvement of the insula and the possible limitation of the good postoperative outcomes after the surgery in these two patients with temporal epilepsy. Conclusion:refractory temporal seizures are often associated with insular seizures, hence the importance of acareful patient history and videoEEG monitoring to predict the degree of postoperative success.


ID : 200480


TITLE : WEBBASED ELECTROENCEPHALOGRAPHY TRAINING IN AFRICA

Author : TUCKER Lawrence [1] , Lee Pan E [1] , Bartel P [1] , Eastman [2]

Affiliation : [1]1University of Cape Town, South Africa 2Neurological Association of South Africa(NASA), [2]3University of Pretoria, South Africa

TOPIC : Epilepsy

ABSTRACT : Purpose: Many neurological diagnoses such as epilepsy and encephalopathy remainclinicallybased but EEG is an extremely useful tool when used to bolster those clinical diagnoses. Ingood hands, EEG can be of immense benefit but, where used by inexperiencedelectroencephalographers, it may result in misdiagnosis and serious harm. Although EEG machinesare now affordable and widely available in Africa, there are few centres on the continent where theskills necessary to perform, read and clinically apply EEG can be learnt. Webbased distanceteaching may assist in this respect. Method: The Neurological Association of South Africa (NASA)has developed an intensive 6month, 9module, webbased, EEG learning programme (EEGonline).The programme consists of two 3month courses covering, respectively, Basic Principles of EEG andApplication of EEG in Clinical Practice. Succinct text is provided, but the emphasis of the teaching ison the interpretation of many normal and abnormal interactive EEG epochs presented in the coursematerial, as well as audiolectures and teaching videos in which experiencedelectroencephalographers run through instructive EEG recordings and learnerparticipation infocused, tutorled discussion fora. Regular selfassessment quizzes are included and the progress ofeach participant is monitored throughout the course. Results: Twelve neurology registrars enrolledfor the first EEGonline programme in October, 2016, and based on postmodular assessments todate, EEGonline will fulfil expectations as an effective teaching tool in Africa. Conclusion: Webbasedtraining such as EEGonline is likely to prove a costeffective distance learning method to overcomedeficiencies in clinical electrophysiology training in resource constrained regions. Funding: WorldFederation of Neurology, International League against Epilepsy.


ID : 200484


TITLE : POSTSTROKE VASCULAR COGNITIVE IMPAIRMENT: INSIGHTS FROM THE COGFASTNEWCASTLE – NIGERIA STUDY

Author : Rufus Akinyemi [1]

Affiliation : [1]


ABSTRACT : Abstract: Populations are ageing all over the world, and there are projections that LMICcountries will be worst hit by 2050. It is estimated that one in three people all over the world will, overa lifetime, develop a stroke, dementia or both but we do not yet fully understand how brain injury fromstroke leads to cognitive impairment and dementia. Recent literature suggests a rising burden of noncommunicable disorders including stroke in Africa but little is known about strokerelated vascularcognitive impairment (VCI) on the continent. The Cognitive Functions After Stroke (CogFAST)Newcastle – Nigeria Project involves clinicopathological investigations in Newcastle and clinicoepidemiological studies in southwestern Nigeria aimed at unravelling the mechanisms of post strokeVCI as well as the profile and determinants of poststroke VCI in Nigerian Africans. Our findingssuggest that several factors including degenerative and vascular pathologies, synaptic densities,white matter changes and neuronal volumes interact to determine the cognitive trajectory after strokeinjury. We also found a high frequency of early VCI in older Nigerian stroke survivors. Apart from olderage and medial temporal lobe atrophy; educational level and prestroke diet were identified asmodifiable factors. The implications of these findings for the development of neuroprotective andtherapeutic strategies, optimal brain health and policy formulation will be highlighted during thelecture.


ID : 200489


TITLE : GENETICS AND NEUROLOGY

Author : Albert Akpalu [1] , R Akinyemi [1] , M Owolabi [1]

Affiliation : [1]

TOPIC : Impact of modern molecular genetics on clinical practice

ABSTRACT : A review of the current studies conducted on Genomic studies on stroke in Ghana andNigeria will be discussed under the NIH H3Africa sponsored SIREN study. Currently 6,000 casecontrol pairs are being analyzed and an African chip for GWAS analysis is being pursued. The needfor expertise in Genomics and bioinformatics cannot be overemphasized across the subrgeion andthe gains and information from these new studies will offer great insights into the genetics andphenomics and management of Stroke in Africa


ID : 200490


TITLE : MUCUNA PRURIENS IN PARKINSON’S DISEASE: AN INTERNATIONAL MULTICENTRE,NONINFERIORITY, RANDOMISED, CONTROLLED CLINICAL TRIAL.

Author : Albert Akpalu [1] , Fred Sarfo2 [2] , Roberto Cilia3 [3]

Affiliation : [1]Korle Bu Teaching Hospital, Ghana, [2]Komfo Anokye Teaching Hospital, Ghana, [3]Parkinson Institute, Milan, Italy


ABSTRACT : Background. Hundreds of thousands of individuals with Parkinson’s disease (PD) inlowincome countries worldwide remain either undertreated or untreated due to unavailability and/orunaffordability of longterm levodopa therapy. Mucuna pruriens (MP) is a leguminous plant growing inall tropical areas worldwide, whose seeds contain high concentrations of levodopa. General Aim. Inthis international multicentre, randomised, controlled study, we aim to demonstrate the noninferiorityof longterm intake of Mucuna powder (in terms of efficacy and safety) compared to standard therapywith Levodopa+Benserazide tablets. Methodology. A total of 90 patients with PD will be enrolled in themulticentre study (of these, n=20 will be recruited at the KBTH and n=10 at the Comboni Hospital).Patients will be randomised in 1:1 ratio to receive the either (1) levodopa/benserazide 200+50mg oraltablets, or (2) MP powder (obtained directly from roasted seeds without any pharmacologicalprocessing). Primary endpoint is the noninferiority of MP in the summary index of a questionnaire onquality of life (the 39item Parkinson’s Disease Questionnaire, PDQ39). Safety measures includeoverall tolerability and any adverse event. Expected Outcome. We expect that the intake of MPpowder will be noninferior to marketed levodopa preparations in terms of both efficacy and safety.We hope that these results will conclusively demonstrate that MP is a safe and effective alternativesource of levodopa to treat individuals with PD who cannot afford longterm therapy with marketedpharmaceutical levodopa preparations.


ID : 200507


TITLE : STROKE AND HIV INFECTION IN CAMPUS TEACHING HOSPITAL OF LOMé

Author : BALOGOU Agnon A. Koffi [1] , FIAWOO Mawuto [1] , DIATEWA Josué [1] , EKOUEVIDidier Koumavi [2]

Affiliation : [1]Service de neurologie de Lomé , [2]Département de santé publique Faculté desSciences de la Santé Université de Lomé


ABSTRACT : Background and purpose: HIV/AIDS and his antiretroviral therapy use are associatedwith higher risk of cardiovascular disease such as stroke. In this study, we estimated the prevalenceof HIV and his associated risk factors in stroke hospitalized patients. Methods: A crosssectional studywas conducted in the Neurological Department of the University Hospital Campus Lomé, Togo, from1st August 2012 to 28 February 2013. All patients hospitalized for stroke based on clinical and braincomputerized tomography scan were enrolled. HIV serology with two fast serial testing wasconducted as well as biological assessments and imaging in search of cardiovascular risk factors. Alogistic regression analysis was performed to identify factors associated with HIV infection. Results: Intotal 444 patients were enrolled. The median age was 57 years (interquartile range of 4468 years)with 53.7% of female subjects. Of these patients, the diagnosis of ischemic stroke was confirmed in309 (69.6 %) patients and that of hemorrhagic stroke in 145 (30.4 %).HIV prevalence was 8.1 % (n =36) with a confidence interval (CI) 95% (from 5.6 to 10.6 %).Among HIVpositive patients, 25 (69.4 %)patients had an ischemic stroke and 11 (30.6 %) patients had a hemorrhagic stroke. The logisticregression analysis showed that the type of stroke was not associated with HIV infection with an oddsratio of 0.63, 95% CI (0.10 to 4.02). Hypertriglyceridemia was more frequent (63.9 %) among HIVpositive patients. Conclusion: This study of HIV seroprevalence conducted in patients hospitalized forstroke shows a high HIV prevalence compared to the national prevalence (2.9 %).Neurology servicesmust continue the treatment of HIV in their structure by making a routine HIV testing in patients withstroke.

infarctus latéral bulbaire : à propos de deux cas … · af f i l i a t i o n : [1] ... à propos...

Documents