Emmanuel Sagui

Ischemic and Hemorrhagic Strokes in Dakar, Senegal A Hospital-Based Study

Background and Purpose— Basic stroke features are hardly known in sub-Saharan countries, and no data are available in Senegal. Methods— We performed a retrospective hospital-based study in Dakar, Senegal, to assess risk factors and etiology of stroke. Patients were recruited from January 1, 2003, to July 31, 2004, at the Hôpital Principal, Dakar. Strokes had to be ascertained by computed tomography. Results— A total of 107 patients were studied. Seventy percent of strokes were of ischemic nature. For ischemic strokes, mean age was 64.2 years. Hypertension was the main risk factor, occurring in 68%, and diabetes was encountered in 37.3%. Lacunar strokes and cardioembolism accounted for 20% and 13.3%, respectively. Because of the lack of systematic investigations, two thirds of strokes were of undetermined origin. Mortality within 1 month was 38%. For hemorrhagic strokes, mean age was 51 years and 1 month mortality was 56%. Conclusion— Hypertension is the main risk factor for both ischemic and hemorrhagic strokes in this hospital-based study.

Is there a link between exertional heat stroke and susceptibility to malignant hyperthermia

Objective The identification of a predisposition toward malignant hyperthermia (MH) as a risk factor for exertional heat stroke (EHS) remains a matter of debate. Such a predisposition indicates a causal role for MH susceptibility (MHS) after EHS in certain national recommendations and has led to the use of an in vitro contracture test (IVCT) to identify the MHS trait in selected or unselected EHS patients. The aim of this study was to determine whether the MHS trait is associated with EHS. Methods EHS subjects in the French Armed Forces were routinely examined for MHS after experiencing an EHS episode. This retrospective study compared the features of IVCT-diagnosed MHS (iMHS) EHS subjects with those of MH-normal EHS patients and MH patients during the 2004–2010 period. MHS status was assessed using the European protocol. Results During the study period, 466 subjects (median age 25 years; 31 women) underwent MHS status investigation following an EHS episode. None of the subjects reported previous MH events. An IVCT was performed in 454 cases and was diagnostic of MHS in 45.6% of the study population, of MH susceptibility to halothane in 18.5%, of MH susceptibility to caffeine in 9.9%, and of MH susceptibility to halothane and caffeine in 17.2%. There were no differences in the clinical features, biological features or outcomes of iMHS EHS subjects compared with those of MH-normal or caffeine or halothane MHS subjects without known prior EHS episode. The recurrence rate was 12.7% and was not associated with MH status or any clinical or biological features. iMHS EHS patients exhibited a significantly less informative IVCT response than MH patients. Conclusions The unexpected high prevalence of the MHS trait after EHS suggested a latent disturbance of calcium homeostasis that accounted for the positive IVCT results. This study did not determine whether EHS patients have an increased risk of MH, and it could not determine whether MH susceptibility is a risk factor for EHS.

Moderate Thermal Strain in Healthcare Workers Wearing Personal Protective Equipment During Treatment and Care Activities in the Context of the 2014 Ebola Virus Disease Outbreak

The extent of thermal strain while wearing personal protective equipment (PPE) during care activities for Ebola virus disease patients has not yet been characterized. From January to March 2015, 25 French healthcare workers (HCWs) in Conakry, Guinea, volunteered to be monitored while wearing PPE using an ingestible thermal sensor. The mean (standard deviation) working ambient temperature and relative humidity were 29.6 °C (2.0 °C) and 65.4% (10.3%), respectively; the mean time wearing PPE was 65.7 (13.5) minutes; and the mean core body temperature increased by 0.46 °C (0.20 °C). Four HCWs reached or exceeded a mean core body temperature of ≥ 38.5 °C. HCWs wearing PPE for approximately 1 hour exhibited moderate but safe thermal strain.

Is Muscle Energy Production Disturbed in Exertional Heat Stroke

BACKGROUND Exertional heat stroke (EHS) is a life-threatening disease that shares some clinical similarities with malignant hyperthermia (MH). By use of (31)Phosphorus magnetic resonance spectroscopy (MRS), EHS patients with MH susceptibility and MH patients shared common metabolic abnormalities. The aim of this study was to determine whether subjects who suffered from an EHS episode had disturbed muscle energetics. METHOD This retrospective study was performed within the French database of military subjects that were explored from 2004 to 2010 after they suffered an EHS. All subjects had both in vitro contracture test to determine their MH susceptibility and (31)Phosphorus MRS at 4.7 Tesla to assess muscle energetics by means of MRS score, a composite score corresponding to the sum of metabolic abnormalities recorded during a standardized rest-exercise-recovery protocol. RESULTS 437 subjects were investigated and 32.5% of them exhibited abnormal MRS score. MRS score did not segregate subjects on demographic, clinical, or biological grounds. No clear correlation could be done between MH status and MRS score. DISCUSSION These results did not confirm the potential relationship between calcium homeostasis and muscle energetics previously reported. However, muscle energy production was disturbed in a significant number of EHS subjects.

Névrite optique à Mycoplasma pneumoniae

Optic neuritis (ON) is an inflammatory disease whose etiology remains obscure. We report a case of ON attributable to Mycoplasma pneumoniae (MP). A 26-year-old man presented a sudden onset bilateral loss of visual acuity, without any history of pulmonary or ear-nose-throat infection. Diagnosis of optic neuritis was made on the basis of visual field loss, though optic disks and visual evoked potentials were normal. Color vision could not be assessed due to a congenital dyschromatopsia. The neurological examination was normal. On magnetic resonance imaging, there was no enhancement or enlargement of optic nerves, but a demyelinating lesion of the cervical spinal cord. Lumbar puncture revealed lymphocytic meningitis with 60 white blood cells, all of them being lymphocytes. Oligoclonal bands were presents in the CSF. With no evidence of any other infection or auto-immune disease, the diagnosis of Mycoplasma pneumoniae infection was established due to the presence of Mycoplasma pneumoniae specific IgM antibodies. Outcome was quite favorable within three months without treatment. Neurological symptoms--encephalitis, meningitis, polyradiculitis, or more rarely ON or cerebella ataxia--are the main extra pulmonary manifestations of Mycoplasma pneumoniae infection. Search for anti-Mycoplasma pneumoniae IgM antibodies should be performed routinely when On is diagnosed.Resume La nevrite optique (NO) est une pathologie rare d’etiologie inconnue. Nous decrivons une NO liee a Mycoplasma pneumoniae (MP), revelee par une nevrite optique bilaterale et asymetrique, survenue sans aucun signe precessif ayant pu faire evoquer une infection broncho-pulmonaire ou ORL. L’examen neurologique, le fond d’œil et les potentiels evoques visuels etaient normaux. L’IRM montrait une plaque medullaire en C2-C3 asymptomatique. La ponction lombaire retrouvait 60 elements blancs faits a 100 p. 100 de lymphocytes, pas de globules rouges, une proteinorachie normale, avec des bandes oligoclonales dans le LCR. Le diagnostic fut serologique par mise en evidence d’anticorps de classe M diriges contre MP. Le reste du bilan serologique ou dysimmunitaire fut normal. L’evolution fut favorable avec regression complete des symptomes en trois mois. Aucun traitement ne fut entrepris. Le diagnostic etiologique d’une NO isolee doit comprendre une serologie envers MP.

Predictive factors of efficacy of rituximab in patients with anti-MAG neuropathy

OBJECTIVE To identify factors associated with efficacy of rituximab (RTX) infusions in patients with anti-myelin associated glycoprotein (MAG) neuropathy. METHODS 33 patients with anti-MAG neuropathy treated with RTX were retrospectively evaluated. All patients underwent neurological, biological, and electrophysiological examinations. Good response was defined as an improvement of at least one point of the Overall Neuropathy Limitation Scale (ONLS) at 6months or at the last follow-up. Disease evolution was defined as sub-acute if the ONLS increased by at least 2 points the year before therapy. RESULTS Ten patients (30%) were improved 6months after RTX and 6/20 (30%) at the last follow-up (mean 42months). Response to RTX was significantly associated with subacute evolution and proximal weakness of the lower limbs at the onset of disease. Improvement was not correlated with electrophysiological data and anti-MAG antibodies titers. DISCUSSION This study suggests that RTX may be efficacious in a sub-population of patients with anti-MAG neuropathy, particularly in those with proximal weakness of the lower limbs or sub-acute evolution.

Occupational Exposures to Ebola Virus in Ebola Treatment Center, Conakry, Guinea

We report 77 cases of occupational exposures for 57 healthcare workers at the Ebola Treatment Center in Conakry, Guinea, during the Ebola virus disease outbreak in 2014−2015. Despite the high incidence of 3.5 occupational exposures/healthcare worker/year, only 18% of workers were at high risk for transmission, and no infections occurred.

A 78-year-old woman with an acute eosinophilic gastroenteritis

Eosinophil accumulation in the gastrointestinal tract is a common feature of numerous disorders including mainly parasitic infection, drug-induced allergic reactions, inflammatory bowel disease, and various connective tissue disorders. Digestive tissue eosinophilia requires thorough searching for secondary causes that may be specifically treated with antibiotics, dietary and drug elimination or immunosuppressive therapy. Frequency, prognosis and therapeutic implications must guide the diagnostic course. An acute eosinophilic gastroenteritis in a 78-year-old asthmatic woman receiving celecoxib is reported. She presented later with neurologic and cutaneous features and was finally treated by methylprednisolone and cyclophosphamide. The diagnostic approach leading to a Churg-Strauss syndrome (CSS) assertion is described. We discuss the pathogenesis, the management and the potential enhancing role of celecoxib in CSS gastrointestinal involvement.

P4-21 Une démence partiellement régressive sous corticothérapie

Introduction Les syndromes dementiels sont le reflet d’une multitude d’etiologies. Avant de porter le diagnostic de maladie d’Alzheimer, une enquete rigoureuse doit etre realisee pour rechercher une etiologie curable. Cas clinique Nous rapportons le cas d’un homme de 47 ans d’origine africaine, suivi depuis trois ans pour un declin cognitif continu. Les premiers symptomes etaient apparus a l’occasion d’un conflit familial, faisant evoquer un episode depressif majeur. Malgre un traitement adapte, l’etat neuro-psychologique du patient s’etait severement deteriore, et le diagnostic de maladie d’Alzheimer a debut precoce avait finalement ete retenu. Les annees suivantes, cet ancien comptable avait perdu toute vie de relation, et demeurait alite en permanence. C’est au decours d’une crise comitiale inaugurale qu’il nous fut adresse. L’exploration d’une toux seche chronique nous amena au diagnostic de sarcoidose pulmonaire, puis a celui d’une neurosarcoidose. Une corticotherapie fut debutee, permettant une amelioration spectaculaire des fonctions cognitives du patient, et une recuperation satisfaisante de l’autonomie. Discussion Le diagnostic de neurosarcoidose est difficile : il repose sur la conjonction de criteres cliniques, biologiques et d’imagerie. Seule une biopsie cerebrale pourrait poser le diagnostic de certitude, mais n’est pas realisee en pratique courante. Les manifestations cliniques sont variees, allant de deficits neurologiques focaux jusqu’a des manifestations psychiatriques, mais les formes pseudo-dementielles sont exceptionnelles. Le traitement repose sur les corticoides oraux, eventuellement associes aux traitements immuno-suppresseurs dans les formes refractaires. Conclusion La neurosarcoidose est une entite clinique peu commune, meme chez les patients atteints de sarcoidose systemique. Ce cas clinique illustre la richesse semeiologique de cette maladie, se presentant ici sous la forme etonnante d’un syndrome dementiel tres avance, en partie corrige par une corticotherapie.

Idiopathic cranial pachymeningitis - diabetes was not the brains

A 58-year-old diabetic woman presented with a 5-week history of sudden-onset diplopia and progressive headache. One week before admission, she also complained of nausea. She reported no history of allergic rhinitis or arthritis. Physical examination revealed isolated left-cranial-nerve VI palsy. Routine biological tests were unremarkable, apart from hyperglycaemia 300 mg/dl and glycosylated haemoglobin 12.4%. Eosinophilia was normal. Lumbar puncture revealed …