Ousmane Cisse

Neuromyelitis optica spectrum disorders (NMO-SD) in a Sub-Saharan Africa country: A preliminary study of sixteen senegalese cases

BACKGROUND Neuromyelitis optica (NMO) is an autoimmune disease of the central nervous system. In Sub-Saharan Africa, publications are rare and deal with isolated cases. Our goal was to analyze the characteristics of NMO spectrum disorders in a Senegalese cohort compiled in Dakar. PATIENTS AND METHOD This was a retrospective descriptive study conducted at the Neurology Department of Fann Teaching Hospital. We included all patients with NMO-SD according to the 2014 diagnostic criteria. RESULTS Sixteen patients were enrolled, 4 men and 12 women with an average age of 30 years. Ten patients (62.5%) presented an acute myelopathy associated with retrobulbar optic neuritis and 5 (31.25%) had isolated spinal cord injury. Spinal MRI showed abnormal cervical (6 patients), dorsal (4 patients), bulbar-cervical (3 patients) or cervico-dorsal (2 patients) signal extended (≥3 vertebral segments) of the spinal cord. Visual evoked potentials (VEP) showed demyelinating optic nerve involvement in 8 patients. Ten patients were positive to AQP-4 IgG. Systemic corticosteroid therapy was the rule in all patients, associated with azathioprine in 10 of them. The clinical course at 3 months was predominantly favourable (10 patients). CONCLUSION This cohort is the first one compiled in Dakar. African multicentric epidemiological studies are needed.

Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study

Objective We describe and compare the sociodemographic and clinical features, treatments, and prognoses and survival times of patients with amyotrophic lateral sclerosis (ALS) in Africa. Methodology We conducted a multicentre, hospital-based cohort study in Africa. Patients with ALS diagnosed in the neurology departments of participating hospitals from 2005 to 2017 were included. Subgroup analysis was performed by subcontinent. Survival analyses were conducted using the Cox proportional hazards model. Results Nine centres from eight African countries participated. A total of 185 patients with ALS were included: 114 from Northern Africa, 41 from Western Africa and 30 from Southern Africa. A male predominance (male to female ratio 2.9) was evident. The median age at onset was 53.0 years (IQR 44.5–64.0 years). The onset was bulbar in 22.7%. Only 47 patients (26.3%) received riluzole, mainly in Northern and Western Africa. The median survival from the time of diagnosis was 14.0 months (95% CI 10.7 to 17.2 months). The median survival was longer in Northern Africa (19.0 months, 95% CI 10.8 to 27.2 months) than in Western (4.0 months, 95% CI 0.8 to 7.1 months) and Southern (11.0 months, 95% CI 5.6 to 16.4 months) Africa (Breslow test, p<0.0001). Both subcontinental location and riluzole treatment independently affected survival. Conclusion More African patients with ALS were male and younger and exhibited a lower proportion of bulbar onset compared with patients with ALS from Western nations. Survival was consistent with that in Western registers but far shorter than what would be expected for young patients with ALS. The research improves our understanding of the disease in Africa.

Pejoratives Factors of African Young People Ischemic Stroke : Experience of Senegal

Introduction: Strokes are frequent and severe, because of the involvement of vital and functional prognosis of patients, especially in young patients living in developing countries. Objective: The main objective of the current study is to identify epidemiological, clinical, paraclinical and etiological predictors of adverse evolution in young adult ischemic stroke. Methodology: Authors conducted a retrospective study at the neurological department of University hospital Fann, Dakar, Senegal, on the records of hospitalized patients from 01 January 2010 to 31 December 2011. Patients aged from 15-55 years in whom the diagnosis of ischemic stroke was selected on the basis of clinical findings and confirmed by a brain scan were included in our study. Results: Authors gathered 116 cases. Mean patient age was 43.5 years with extremes of 19 to 55 years. The main risk factors found in the 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%). The average length of stay in hospital was 16 days. A death rate of 28.4% was observed. The main predictors of adverse evolution identified were the length of stay in the hospital, age, Glasgow Coma Scale (GCS), 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. Conclusions: Glucose acute phase and state of consciousness seem to be predictors of cerebral ischemia. A quick and appropriate management will improve the vital prognosis and better recovery. To cite this article [Dadah, S. M. L., Cisse, O., Boubacar, S., Ba, E. M., Bagher, M. L. M., ... Ndiaye, M. M. (2017). Pejoratives Factors of African Young People Ischemic Stroke: Experience of Senegal. The Journal of Middle East and North Africa Sciences, 3(3), 1-5]. (P-ISSN 24129763) (e-ISSN 2412-8937). www.jomenas.org. 1

Direct Complication of HIV on the Brain: A Case About a Recurrence of Stroke

Only 1% to 5% of HIV patients who develop a direct complications following. HIV infection can result in stroke via several mechanisms, including opportunistic infection, vasculopathy, cardioembolism, and coagulopathy. It is a rare association, here we report the case of a woman of 69 years immunocompromised who Stroke diagnosed without another etiology found despite an etiologic assessment of the most common causes in our context. The patient had received treatment with an overall favorable evolution. Before a stroke recurrent of unknown etiology should think of HIV as this will allow appropriate treatment. The mechanism can be related with syphilis (Vasculitis) or by direct action of the virus on the central nervous system.

Occurrence of Biermer's Disease After 8 Years of Follow-Up of Myasthenia Gravis: About a Clinical Case

The auto immune myasthenia comorbidity and Biermer disease is less documented and rarely brought in the literature. We bring back the observation of a Senegalese patient hospitalized in our department of Neurology at Fann hospital (Dakar). It concerned a patient aged 58 years followed up for auto-immune myasthenia to antibodies anti-receptors of acetylcholine Ac RACH since 8 years and having a benefit of recurrent blood transfusion with a blood group A rhesus positive. He was received on neurologic consultation for a tiredness associated to an effort dyspnea and a gastro esophageal reflux accompanied by vomiting. The interrogatory found palpitations which necessitated a hospitalization two month before. Physical examination had objective a myasthenia syndrome, an anemic syndrome on the other hand, sub icteric mucosa’s were noted but no melanodermia no glossite. The rest of the physical examination was without particularity. The diagnoses of the Biermer illness was carried out in front of the anemic syndrome, the chronicity of the symptomatology without notion of fluctuation and the complementary exams having as objective a low rate of hemoglobin and a deficit in vitamin B12. The origin auto-immune of this anemia was confirmed by the immunologic test which had put in evidence a high rate of anti-bodies anti- intrinsic factor. The patient benefited from a blood transfusion then a treatment from cobalamin (for life) was also installed associated to a symptomatic management of the patient. The evolution after 6 weeks of the treatment was favorable with a complete regression of the dyspnea, vomiting and the attenuation of the effort tiredness. Myasthenia gravis and Biermer disease comorbidity has to be discussed in front of every myasthenia patient presenting clinical signs of effort dyspnea to a chronic anemia because early diagnoses of this association of Biermer illness and myasthenia gravis favors a better prognosis and not to progress to the combined degeneration of the spinal cord. The autoimmune substratum of the mechanism of this comorbidity remains to be elucidated but in all cases multidisciplinary management is necessary.

Diagnosis Approach and Management of Rhombencephalitis: Literature Review

Rhombencephalitis refers to inflammatory diseases of the rhombencephalon. We present here a literature review of this pathology. It was originally described by Edwin Bickerstaff and Philip Cloake in 1951. The terms Rhombencephalitis and trunk encephalitis are interchangeable. It is a rare disease but potentially serious. The symptomatology is characterized, in some cases, by fever and alteration of consciousness, but also headache, nausea and vomiting sometimes. An involvement of the cranial nerves in the majority of the cases and or affected of the long ways. Paraclinically, cerebrospinal fluid and cerebral imaging can be normal in paraneoplastic causes or, on the other hand, be pathological in infectio-inflammatory causes. The etiologies are mainly distinguished in infectious, autoimmune and paraneoplastic pathologies. Treatment should be etiological by anti-infectives (antibiotics, antivirals, etc.) targeting curable germs such as listeria, mycobacterium tuberculosis or herpes, and/or symptomatic by corticosteroid or immunoglobulin IV. Rhombencephalitis is a rare nosological entity but is subject to severe neurological sequelae with a high mortality rate.

A Case of Neuromyopathy Due to Synthetic Antimalarial Drugs

Introduction: Synthetic anti malaria drugs has effectiveness in the treatment of many auto-immune diseases and principally the systemic erythematous lupus. The undesirable effects remain rare. The appearance of myopathy is considered as exceptional. We report observations which highlight the hypothesis of a double toxicity (Chloroquine and Hydroquinine). Observation: We report a case of 53 years old female patient treated chronically by Hydroquinidine and Escitalopram for Bouveret diseases which became asymptomatic. Later on, we had Chloroquine and Prednisone to the previous treatment. Prednisone was removed few months later because of a possible skin side effect. Due to the incomplete relief of joint pain we had Methotrexate to the treatment associated to Omeprazole. And the evolution was characterized by the appearance of lower limbs muscle weakness leading to the interruption of Methotrexate- Omeprazole association. Despite this interruption there was a worsening of the muscle weakness clinically and electro-physiologically diagnosed as myopathy which leads to the interruption of Chloroquine and Hydroquinidine. Other causes of myopathy have been ruled out after a large check-up and Methotrexate was re-introduced two months later with progressive regression of symptoms within six months. Discussion and conclusion: The appearance of myopathy in a patient treated by Chloroquine is extremely rare. Our observation highlights the toxicity of synthetic antimalarial drugs which can cause myopathy in some cases. The association of Chloroquine and Hydroquinidine seems potentially more toxic on muscles.