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Introduction Cerebral venous thrombosis (CVT) are underdiagnosed in sub-saharan Africa where publications are uncommon. Our study aim was to describe the CVT diagnostic and therapeutic features through a senegalese case series. Patients and method A monocentric retrospective and prospective study was conducted at the adult Neurology department of Fann Teaching Hospital in Dakar (Senegal), between January 01, 2013 and April 30, 2020. It had included all CVT cases diagnosed by neurovascular imaging. Results Seventy CVT cases were collected including 48 women (68.6%). The average age of the patients was 35.2 ± 14 years. The main neurological signs were headache (92.8%) and motor deficit (41.4%), with subacute onset in 67.2% of cases. The superior sagittal sinus (54.3%) and the transverse sinus (38.6%) were the most affected with multiple involvements in 27 patients (38.6%). Thirty patients (42.8%) had indirect parenchymal signs such as venous infarction (15.7%), cerebral edema (11.4%) or intracerebral hemorrhage (12.8%). The etiological factors were mostly infectious (41.4%) with meningoencephalitis (12.8%) and otorhinolaryngological infection (10%). Gyneco-obstetric factors (27%) and Behcet's disease (7%) were the main aseptic factors. In the short-term clinical course, curative anticoagulation (98.6%) had enabled a favourable outcome (mRS 0-1) in half of the patients. Conclusion Our study, the largest series in sub-saharan Africa to this date, confirms that CVT is a young women disease. Infectious etiology is the most frequent at the Fann national teaching hospital (41.4% in Dakar against 6.5% in Germaine Bousser's series) even if the etiological assessment is limited by financial constraints (no coagulopathy/thrombophilia check-up).

Senegal is affected by a relatively high prevalence of iodine deficiency disorders, which compromises its social and economic development. To address this situation, the Universal Salt Iodization strategy was adopted by the Senegalese Government. The monitoring of salt iodine status is crucial to the success of such a program. Therefore, this study aimed to evaluate the iodine concentration of table salt from Senegalese households. A total of 1575 samples collected in urban and rural areas were analyzed using the iodometric method. The powdered salt samples showed higher mean iodine content (18.99 ppm) and lower percentage of non-compliance (58.4%) than the other salt types (p = 0.02). Most of the samples collected from urban area were found with iodine content between 15 and 39.9 ppm, whereas, in rural areas, the situation was significantly different (p = 0.01). Iodine levels of most samples were lower than 5 ppm in the rural producing area or varied between 5 to 14.9 ppm in the rural non-producing area. A percentage of 37.3% of adequately iodized salt samples was obtained at a national scale with a significant disparity between urban and rural areas. Therefore, improvements in quality control procedures in tandem with the iodization process are necessary and an information, education and communication strategy should be adopted.

Tolosa–Hunt syndrome is a painful ophthalmoplegia characterized by recurrent unilateral orbital pain, ipsilateral oculomotor paralysis, and a rapid response to steroids. Our report describes a 37-year-old young woman who presented with right ptosis, ipsilateral ophthalmoplegia, and painful headache with no other neurological deficits in which all biological and neuroimaging investigations were normal. Complete recovery within one week of corticosteroid therapy was observed. This is probably the first case of Tolosa–Hunt syndrome reported in Dakar, Senegal.

The photoparoxysmal response (PPR) is defined as the occurrence of generalized spike, spike-wave or polyspike-wave discharges consistently elicited by intermittent photic stimulation (IPS). PPR is not well studied in Sub-Saharan African people. We prospectively studied the epidemiological, clinical, and EEG characteristics of PPR among consecutive patients recorded at the clinical neurophysiology unit of Fann University Hospital (Dakar, Senegal). Among 6,808 EEG recordings including 3,065 pathological EEGs, we collected 56 EEGs with PPR (0.8% of all recorded EEGs and 1.8% of anormal EEGs), from 31 women and 25 men (sex ratio: 0.8). The mean age was 13.3 years (range: 8 months to 59 years). The peak of photosensitivity was found in the range of 6 to 10 years. Of the PPR cases, 12 had clinical manifestations during IPS. Generalized epilepsy was diagnosed in 23 (41%) patients and 18 (32%) had focal epilepsies. The most epileptogenic stimulation frequencies were between 12 and 24 Hz (range: 1-28 Hz). PPR were mainly triggered during eye closure (64%), and 41 patients (73% of PPR cases) were classified as Type 4 (Waltz classification). Our results confirm lower rates of photosensitivity in African Sub-Saharan people compared with others. Although the current data do not support a role of short-term ambient light levels, subject to consistent data from larger cohorts, it may be interesting to study the probable epigenetic-mediated protective role of sunshine against photosensitivity.

Africa is the world’s most genetically diverse, second largest, and second most populous continent, with over one billion people distributed across 54 countries. With a 23% lifetime risk of stroke, Africa has some of the highest rates of stroke worldwide and many occur in the prime of life with huge economic losses and grave implications for the individual, family, and the society in terms of mental capital, productivity, and socioeconomic progress. Tackling the escalating burden of stroke in Africa requires prioritized, multipronged, and inter-sectoral strategies tailored to the unique African epidemiological, cultural, socioeconomic, and lifestyle landscape. The African Stroke Organization (ASO) is a new pan-African coalition that brings together stroke researchers, clinicians, and other health-care professionals with participation of national and regional stroke societies and stroke support organizations. With a vision to reduce the rapidly increasing burden of stroke in Africa, the ASO has a four-pronged focus on (1) research, (2) capacity building, (3) development of stroke services, and (4) collaboration with all stakeholders. This will be delivered through advocacy, awareness, and empowerment initiatives to bring about people-focused changes in policy, clinical practice, and public education. In the spirit of the African philosophy of Ubuntu “I am because we are,” the ASO will harness the power of diversity, inclusiveness, togetherness, and team work to build a strong, enduring, and impactful platform for tackling stroke in Africa.

Background Bacterial meningitis is a major cause of mortality among children under 5 years of age. Senegal is part of World Health Organization–coordinated sentinel site surveillance for pediatric bacterial meningitis surveillance. We conducted this analysis to describe the epidemiology and etiology of bacterial meningitis among children less than 5 years in Senegal from 2010 and to 2016. Methods Children who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d’Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed. Results A total of 1013 children were admitted with suspected meningitis during the surveillance period. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus accounted for 66% (76/115), 25% (29/115), and 9% (10/115) of all confirmed cases, respectively. Most of the suspected cases (63%; 639/1013) and laboratory-confirmed (57%; 66/115) cases occurred during the first year of life. Pneumococcal meningitis case fatality rate was 6-fold higher than that of meningococcal meningitis (28% vs 5%). The predominant pneumococcal lineage causing meningitis was sequence type 618 (n = 7), commonly found among serotype 1 isolates. An ST 2174 lineage that included serotypes 19A and 23F was resistant to trimethoprim-sulfamethoxazole. Conclusions There has been a decline in pneumococcal meningitis post–pneumococcal conjugate vaccine introduction in Senegal. However, disease caused by pathogens covered by vaccines in widespread use still persists. There is need for continued effective monitoring of vaccine-preventable meningitis., Disease caused by pathogens covered by conjugate vaccines in widespread use still persists in Senegal. There is need for continued effective monitoring of vaccine-preventable meningitis.

Neuro-Behcet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behcet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.

Introduction ─ Multidrug-resistant tuberculosis is resistant to isoniazid and/or rifampicin. It is favored by poverty and infection with the human immunodeficiency virus. This retrospective, descriptive study aimed to determine the contribution of Xpert MTB/RIF® in the diagnosis of multidrug-resistant pulmonary tuberculosis in a semi-urban environment at the Peace Hospital of Ziguinchor in Senegal during the period from April 2015 to August 2019.Methodology ─ The study is retrospective, descriptive and carried out in the laboratory of Ziguinchor Hospital de la Paix, in southern Senegal, from April 2015 to August 2019. All respiratory specimens were subjected to Ziehl-Neelsen-stained smear microscopy and Xpert MTB/RIF® testing.Results ─ 180 samples, i.e. 6.4% were microscopy-negative but positive in Xpert MTB/RIF® testing. 32 patients (1%) are infected with rifampicin-resistant M. tuberculosis, against 29% of patients (798/2794) infected with susceptible strains.Conclusion ─ Tuberculosis is not longer a “disease of the past”. Having a high cost, Xpert MTB/RIF® testing must be associated with microscopy, which remains accessible in semi-urban areas and is easy to perform.

Guillain-Barre Syndrome (GBS) is an acute autoimmune polyradiculoneuropathy, that often follows an antecedent infection. Leishmaniasis is a zoonosis due to a flagellate protozoan of the Leishmania genus and transmitted by the sandfly. Here we report a 15 years old teenager who presented with an ascending installation of the motor deficit in three weeks associated with dysphonia and swallowing disorders. The physical examination showed a flaccid proximo-distal quadriparesis, akinesthesia, apallesthesia and cutaneous lesions on the forehead, wrist and calf that appeared two months earlier. The HIV serology was negative and cerebro-spinal fluid examination was normal. The electroneuromyography showed a reduction in motor and sensitive amplitudes with an increase in distal latencies and F waves in the upper limbs and segmental and focal conduction blocks. Parasitological examination of the dermal juice around the edges of the skin lesions revealed amastigote forms of leishmaniasis. The evolution was favorable with only symptomatic treatment.

Background and Aims: Initially barely affected by the COVID-19, the African continent suffered a second violent wave this winter. Neurological manifestations worldwide are increasingly reported, dominated by encephalitis, stroke and polyradiculoneuritis. We report the Senegalese experience of Neurocovid through a series of 9 patients. Methods: This is a prospective study of patients hospitalized in the neurology department of Fann. Were included patients who had neurological manifestations during or following an COVID-19 infection defined by a positive PCR or a recent infection with ELISA serology or typical chest imaging. Results: We collected 9 patients (6 men and 3 women), aged 7 to 80 years. Diagnoses were: 3 encephalitis, 4 polyradiculoneuritis, 1 hemorrhagic stroke and 1 chorea. 4 patients had comorbidities. The delay for neurological signs appearance was 11.1 days. A nasal swab was positive on 5/8 patients. Antibodies were found in all 3 negative patients. The LCR study showed hyperproteinorrachia in 7/9 patients. 5 patients underwent CT chest scan, showing ground glass opacities. Brain imaging was normal in 3 and pathological in 2, showing a parietal temporo hematoma fx1 in one and mesencephalic and parietal hypersignal in the other fx2 50% of patients with polyradiculoneuritis had an ENMG that showed an AIDP. One patient had an electroencephalogram that showed an overall slowing of the pattern with diffuse pseudoperiodic complexes fx3. Evolution was good for 6 patients but we noticed 3 deaths. [Formula presented] [Formula presented] [Formula presented] Conclusions: Neurological manifestations most often occur in post-infection. The creation of a multidisciplinary team will allow a better understanding of the sequel as of patients with COVID-19.

Introduction: In sub-Saharan Africa, acute stroke management is lacking, as is etiological research and gestion of the common complications, often resulting in patients’ death. Atelectasis, is the complete or partial collapse of an area (lobe) of the lung; it is one of the most common respiratory complications after surgery. However, atelectasis is a relatively rare lung disease following a stroke. Case presentation: We report the case of an 84-year-old man, non-alcoholic-smoking and irregularly followed for high blood pressure on a heart disease for several years. He suddenly presented a right brachiofacial spastic hemiplegia with aphasia, rapidly followed by consciousness' troubles correlated with a mixed-mechanism ischemic stroke: embolic and atheromatus. After clinical improvement under symptomatic treatment, he suddenly presented an acute febrile respiratory distress at day 7 of hospitalization causing a suspected pulmonary embolism but with evidence on thoracic CT scan of a bilateral pleuropneumopathy with near-total atelectasis of the left lung. Evolution was unfavourable after a 15-day transitional improvment. Conclusions: Although unusual, an pulmonary atelectasis should be sought in cases of acute rebellious respiratory distress on a patient with a stroke. Management must be quick and collaborative to improve prognosis. Also, it is essential in our African context to systematize and repeat chest X-rays in case of leukoariosis on brain imaging, which is a fertile ground for the occurrence of pseudo-bulbar disorders, especially deglutition troubles.

Metastatic spinal cord compression (MSCC) is a medical emergency that requires rapid diagnosis and treatment to reduce pain, to preserve neurological functioning, and to prolong survival. The diagnosis of liver cancer is often neglected in the differential diagnosis of MSCC. Treatment is usually palliative and evolution is often fatal. This is a case report of a 28-year-old patient living in Mauritania hospitalized in November 2014 at the neurology department of Fann national teaching hospital in Dakar, for the management of a chronic dorsal spinal cord compression. The radiological and laboratory investigations done revealed the metastatic compression originating from a liver cancer with elevated alpha-fetoprotein and aspartate transaminase, positive hepatitis B surface antigen, and multiple metastasis in the lungs, mediastinum, ribs, iliac, and peritoneum. The hip joint X-ray showed a spontaneous fracture of the right femoral neck. The multidisciplinary treatment was palliative and the evolution was fatal within the month of hospitalization. Earlier diagnosis and treatment of MSCC may not have saved the life of the patient but may have prevented much suffering and would likely have prolonged the life of a young man.

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

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

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

Ivermectin is an ant parasitic drug used for combating onchocerciasis and lymphatic filariasis. It works by inhibiting the function of neurons and muscles, thus causing paralysis of microfilariae. Side effects of this drug have been reported including post-ivermectin encephalopathy requiring emergency care in hospital. We report the case of a 35 years old patient living in rural areas of Senegal who presented two days after a mistake in administration of a second dose of ivermectin, headaches, altered consciousness and bilateral blindness. The workup revealed brain white matter lesions, abnormal liver function tests and biological inflammation without evidence of Loa loa microfilariae in blood and cerebrospinal fluid. Corticosteroid treatment was administered in emergency and patient recovered despite the persistence of bilateral blindness. Inflammatory process seems to have an important role in the pathophysiology of this encephalopathy. We should therefore carefully control the administration of this drugs.

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

In May 2012, the Division of AIDS Research at the National Institute of Mental Health (NIMH) organized the "Global NeuroAIDS Roundtable" in conjunction with the 11th International Symposium on Neurovirology and the 2012 Conference on HIV in the Nervous System. The meeting was held in New York, NY, USA and brought together NIMH-funded investigators who are currently working on projects related to the neurological complications of AIDS (NeuroAIDS) in Africa, Asia, Eastern Europe, and Latin America in order to provide an opportunity to share their recent findings and discuss the challenges encountered within each country. The major goals of the roundtable were to evaluate HIV-associated neurocognitive impairment and determine if it may be directly attributable to distinct HIV subtypes or clades and to discuss the future priorities for global NeuroAIDS research. At the "Global NeuroAIDS Roundtable", presentations of preliminary research indicated that HIV-associated neurocognitive impairment is prevalent in all countries examined regardless of which HIV clade is present in the region. The only clear-cut difference between HIV-1 clades was in relation to subtypes A and D in Uganda. However, a key point that emerged from the discussions was that there is an urgent need to standardize neurocognitive assessment methodologies across the globe before definitive conclusions can be drawn regarding the relationship between HIV clade diversity and neuropathogenesis. Future research directions were also discussed at the roundtable with particular emphasis on the potential of viral and host factor molecular interactions to impact the pathophysiology of HIV-associated neurocognitive disorders (HAND) from a global perspective. © 2013 Journal of NeuroVirology, Inc. (outside the USA).

Introduction Les Encephalopathies Epileptogenes precoces avec « suppression burst » sont graves du fait de leur pharmacoresistance et l’impact sur le developpement psychomoteur des enfants atteints. Notre objectif est d’en identifier les determinants chez des patients a Dakar. Methodologie Il s’agissait d’une etude retrospective et prospective a partir de dossiers medicaux allant de janvier 2013 a janvier 2015, realisee a la clinique Neurologique du CHNU Fann et portant sur des enfants qui y sont suivis. Elle n’a interesse que les patients avec epilepsie precoce, retard du developpement psychomoteur et pattern de suppression burst a l’EEG. Les aspects anamnestiques, cliniques, electro- encephalographiques et evolutifs sous traitement ont ete evalues. Resultats Nous rapportons quatre observations d’enfants avec une notion d’epilepsie familiale non documentee chez deux, qui ont presente une encephalopathie precoce avec des crises epileptiques polymorphes dominees par des crises toniques. Celles-ci ont debute le premier jour de vie chez deux enfants, a 30 jours de vie et en debut du troisieme mois de vie chez les deux autres. L’EEG de sommeil realise au moment du diagnostic a montre un pattern de suppression burst. Aucune etiologie n’a ete retenue du fait de la limitation du bilan complementaire a visee etiologique tel que l’IRM cerebrale ou les bilans metaboliques. L’evolution electro-clinique est favorable pour certains patients avec le traitement entrepris, base principalement sur le valproate de sodium a une dose de 20mg/Kg/jr en moyenne. Elle est marquee par la disparition des crises ou leur diminution en frequence et par l’amelioration du trace EEG de sommeil de controle avec disparition des bouffees suppressives chez trois patients, tandis que chez le quatrieme, l’evolution s’est faite vers un autre type d’encephalopathie epileptogene qu’est le syndrome de West. Le retard psychomoteur est reste patent chez la totalite des patients. Conclusion Les resultats de ce travail ouvrent la perspective a des etudes complementaires notamment longitudinales qui permettraient de mieux individualiser ces pathologies graves a debut precoce d’autant plus qu’il existe des causes curables. Introduction Early epileptic encephalopathies with "suppression burst" are serious because of their drug resistance and the impact on psychomotor development of children involved. Our objective is to identify the determinants of this pathology in Dakar. Methodology This is a retrospective and prospective study from medical records from January 2013 to January 2015, performed on children who followed at the Neurological clinic of Fann University Hospital of Dakar. It has interested patients with early epilepsy, delayed psychomotor development and EEG pattern of suppression burst. Anamnestic, clinical, electroencephalographic and progressive aspects under treatment were evaluated. Results We report four cases of children with epilepsy notion of family in two undocumented, who presented early encephalopathy with seizures polymorphic dominated by tonic seizures that began on the first day of life in two, 30 days of life and the beginning of the third month of life in the other two. The sleep EEG performed at diagnosis showed a pattern of suppression burst. No etiology was chosen because of the limitation of additional balance sheet etiological such as MRI cerebral or metabolic balance sheets. The electro-clinical evolution is favorable for some patients with the treatment undertaken, based mainly on sodium valproate at a dose of 20mg/Kg/day in average. It is marked by the disappearance of seizures or decreased in frequency and by improving the sleep EEG control monitoring with disappearance of suppression burst in three patients, while in the fourth, the change was made to another type of epileptic encephalopathy that is the West syndrome. Psychomotor retardation remained evident in all patients. Conclusion The results of this work open up the prospect for further studies including longitudinal that would better individualize these serious early diseases especially because it exists treatable causes.

Introduction: Hemorrhagic Stroke (HS) are uncommon among children. They have an etiological specificity and different risk factors that are different from those of adults. Prognosis depends on the etiology. Our objective was to study the characteristics of children's HS in Senegal. Methodology: Descriptive retrospective study from July 2003 to February 2014. Results: 13 patients were collected, including 9 boys. The mean age was 9.85 years. The antecedents were: rheumatic heart disease (2 patients); congenital heart disease (1 patient); arterial hypertension systolic-diastolic untreated (1 patient); heterozygous sickle cell anemia (1 patient). No history for (8 patients - 61.53%). The beginning was sudden or rapidly progressive in all patients. Clinical manifestations were hemiplegia (53.84%), headache and vomiting (46.15%), consciousness disorders (30.76%), partial motor seizures (7.69%). The topography was supratentorial (84.61%). The causes were: arteriovenous malformations (3 patients); severe thrombocytopenia (1 patient); systolic-diastolic arterial hypertension (1 patient); myeloblastic leukemia (1 patient). No etiology (7 patients). 4 patients died during the acute phase. 1 patient was transferred to pediatric oncology. 1 patient was transferred abroad for embolization. The mean follow-up was 11.8 months. Outcome was favorable in patients with ad integrum restitution. 7 patients had hemiparesis type of neurological sequelae (4 patients), motor partial epilepsy (4 patients) and aphasia (1 patient). 1 patient developed hydrocephalus. No recurrence was noted. Conclusion: This study provides a better diagnostic and etiological approach for better management.

Myasthenia gravis is a rare disease with very few confirmed cases described in the African setting. We report the case of a 41-year-old woman with a history of type 2 diabetes, high blood pressure (well monitored), and migraine with aura. She was received at the outpatient neurology consultation for a left ptosis, diplopia, chewing and walking difficulties. She reported abnormal and fluctuating muscle fatigability at effort, responsible for several falls. These symptoms were marked at evening, and were evolving since four years before her consultation in our center. She also reported a history of palpitations, exertional dyspnea, dysphonia, dysphagia and 20 kg weight loss. Neurological examination found a horizontal diplopia, a left ptosis and abnormal weakness at dynamic eyes and limb muscles testing. Otherwise the remaining neurological examination was unremarkable. Repetitive nerve stimulation found a significant compound muscle action potentials decrement. The immunological tests showed a very high level of antibodies to acetylcholine receptors (anti-AChR) at 1220.00 nmol/l (normal value

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.

OBJECTIVE To evaluate the functional outcome in patients followed in the department of neurology of Dakar for stroke. MATERIALS AND METHOD Prospective longitudinal observational study from August 2003 to May 2005 included inpatients or outpatients with stroke one month or less from entry confirmed by computed tomography scan. Patients were followed monthly for 12 months. At each visit, data on functional autonomy measured by the Barthel index and the treatments received were collected. RESULTS One hundred and seventy patients aged 25 to 90 years (mean 61+/-13 years) were evaluated. The sex ratio was 0.68. A total of 64.7% of strokes involved ischemic cerebral vascular accidents and 35.3% hemorrhagic vascular accidents. Right hemiplegia was present in 55.9%, left hemiplegia in 42.9% and bilateral paresis in 1.2% of patients. A total of 28.8% of patients died between d0 and d30, 50.6% within one year. At entry, the Barthel score was greater than 60 in only 4.7% of patients. After one-year follow-up, 58.3% of the patients had a Barthel score greater than 60, 19.1% had a score between 20 and 40 and 22.6% a score between 40 and 60. Only 53.5% received rehabilitation care. The parameters significantly associated with a functional recovery were age less than 55 years (P

One of the leading brain disorders in developing countries is represented by epilepsy. It is estimated that 80% of people suffering from epilepsy around the world, reside in developing world such as Africa. Many perinatal and postnatal causes are brain-stressers in people suffering from malnutrition and low economical conditions. This context is characterised by long delay before modern treatment, reduced number and financial inaccessibility to anti-epileptic drugs (AEDs) and limited human and technical resources for epilepsy. Cultural interpretation also contributes to exclude epileptic patients from the educational and productive fields, aggravating the burden they face and favouring a treatment gap estimated to 80%. To fight against this dramatic reality, a partnership has been built between the International League against Epilepsy, the International Bureau for Epilepsy and the World Health Organisation, named the "Global Campaign Against Epilepsy" "Epilepsy Out of the Shadows" to reduce treatment gap and social and physical burden, educate health personnel, dispel stigma, support prevention.

Cryptococcus meningitis is uncommon in childhood. We report a Senegalese case of cryptococcus meningitis diagnosed in an apparently immunocompetent child. A 9-year-old boy was admitted for acute meningoencephalitis. A computerized tomography scan of the brain showed an ischemic lesion in the left caudate and study of cerebrospinal fluid (CSF) revealed cytological and biochemical abnormalities and Cryptococcus neoformans on direct exam and culture. HIV and syphilis antibodies were negative and the blood CD4 lymphocyte count was 804/mm(3). The child had no immunocompromising factors such as hematologic abnormalities, solid tumor, or undernutrition. He was treated with fluconazole intravenously, but clinical outcome was unsuccessful. The patient died after 1 month from cardiovascular and respiratory distress.

Objective Therefore, the aim of our study was to determine risk factors for poor quality of life by considering disability after stroke in its multidimensional aspects but also to see the impact of each risk factor on the dimensions of quality of life. Material/Patients and methods A prospective study of stroke patients confirmed, followed by neurovascular consultation at Fann Hospital in Dakar has been achieved. Quality of life was evaluated by the 65 Sikness Impact Profile (SIP 65), the depression by the scale of Beck. Results We included 70 men and 30 women with a mean age of 55.25 years. The education rate was 56.12%. Hypertension (65%); musculoskeletal diseases (26.26%) were the major associated defects. Ischemic stroke was predominant. Depression was observed in 53% of cases. The outputs of the house and in the city were respectively arrested in 50% and 73% of cases. Most of the patients, 61%, were conducting any activity at home. Age was associated with an orientation problem in time significantly ( P = 0.02), musculoskeletal diseases to need help dressing ( P = 0.03); the degree of disability to need help to sit and sleep ( P = 0.00003), a lack of sleep the night ( P = 0.00002) and a home asset; depression suffering of sexual life ( P = 0.002), a shortened working time ( P = 0.005) and reduced leisure time ( P = 0.0004). Discussion - Conclusion The sedentary post stroke Senegalese patients can’t be explained solely by altering the physical dimensions of quality of life. All the more that disability assessed by the Barthel showed that locomotion is possible in over 50% of cases.

With the ageing of the population, dementia is increasing. In Africa, studies on dementia of the elderly are seldom. However, dementia exists and is not well documented in Senegal especially among the elderly population. We conducted a study to estimate the prevalence of this disease among Senegalese elderly population utilizing the Medico Social and University Center of IPRES, Dakar-Senegal. The study was cross-sectional and intended, through a two-wave process of data collection, to collect data from March 2004 to December 2005 among Senegalese elderly population (aged 65 years) over utilizing the MedicoSocial and University Center of IPRES, Dakar-Senegal for health care. Sociodemographic, medical history, lifestyles and social network data were collected with a structured questionnaire completed with a clinical examination and neuropsychological testing. Diagnosis of dementia was based on DSM IV criteria. The population composed of 507 patients with a mean age of 72.4 years (±5.25), mostly male, married, and non-educated. Hypertension, arthritis, gastro-intestinal, respiratory and urinary diseases were the main health conditions reported. The elderly population had a high social network. 45 patients (8.87; 95% IC: 7.61 to 10.13) had dementia in which prevalence varied significantly with age, education and social network. The results confirm the variability of dementia with age, education and social network at the Medico Social and University Center of IPRES, Dakar-Senegal. Keywords: Dementia, prevalence, education, elderly person, Senegal

In July 2009, the Center for Mental Health Research on AIDS at the National Institute of Mental Health organized and supported the meeting “NeuroAIDS in Africa.” This meeting was held in Cape Town, South Africa, and was affiliated with the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Presentations began with an overview of the epidemiology of HIV in sub-Saharan Africa, the molecular epidemiology of HIV, HIV-associated neurocognitive disorders (HANDs), and HAND treatment. These introductory talks were followed by presentations on HAND research and clinical care in Botswana, Cameroon, Ethiopia, The Gambia, Kenya, Malawi, Nigeria, Senegal, South Africa, Uganda, and Zambia. Topics discussed included best practices for assessing neurocognitive disorders, patterns of central nervous system (CNS) involvement in the region, subtype-associated risk for HAND, pediatric HIV assessments and neurodevelopment, HIV-associated CNS opportunistic infections and immune reconstitution syndrome, the evolving changes in treatment implementation, and various opportunities and strategies for NeuroAIDS research and capacity building in the region.

It is time to end the underappreciation of the burden of neurological disorders in global health.1 The Chairman of the Commission of the African Union, Alpha Oumar Konare, recently claimed that Africa now confronts the world’s most dramatic public health crisis.2 Sub-Saharan Africa has become the poorest region in the world. Many countries still suffer from the legacies of colonialism and slavery. Interethnic conflicts add to the problems. With a population of about 700 million, around 45% live for less than a dollar a day. The medical infrastructure is poorly developed and has approached collapse in some areas. The AIDS situation represents an additional socioeconomic problem. There is a lack of hospital beds for neurologic disorders in sub-Saharan Africa. The median number of neurologic beds per 10,000 population in low-income countries is 0.03, compared with 0.73 in high-income countries. Neurologists are scarce and unequally distributed. In Europe, there is one specialist per 20,000 population; in Africa, one per 3 million people. Less than 50% of the sub-Saharan African countries have neurologic societies. There is a lack of nurses and subspecialized neurologic services (neurologic rehabilitation, EEG, EMG, neuroradiology, and stroke units), facilities for postgraduate training are poorly developed, more than two thirds have no disability benefits available, and basic drugs used for neurologic disorders may not be available or are too expensive. While social insurance is the most important source of financing health service in Europe, none of the responding countries in Africa use social insurance as the primary method of financing. Out-of-pocket expenditure is still the primary method of financing in 84.2% of low-income countries. This is likely to result in further inequity of neurologic services. The major conclusion is that the available resources are insufficient to meet the global burden associated with neurologic disorders.3 Neurologic and …

WCN 2013 No: 983 Topic: 3 — Stroke Cerebrovascular risk factors and depression: Report from National Ambulatory Medical Care Survey 2002–2009 H. Egila, B. Rahim, M.A.K. Suri, M.F.K. Suri, A.I. Qureshi. Neurology, Zeenat Qureshi Stroke Research Center, Minnesota University, Minneapolis