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A 42-year-old woman presented with a 6-month history of diffuse headache of moderate intensity and gradual onset of generalized weakness, imbalance, apathy, memory decline, hypophonia, dysphagia, constipation and urinary incontinence. Clinical examination revealed several elements of a frontal lobe dysfunction including apathy with motor impersistence, presence of primitive reflexes, generalized hyperreflexia with bilateral Hoffman sign and ankle clonus. The biological workup was unremarkable and a brain computed tomography scan identified a giant olfactory groove meningioma. A prompt neurosurgical intervention helped to reverse the symptoms. This case illustrates the benefits of actively looking for treatable conditions in young patients presenting with acute or subacute dementia and emphasizes the pivotal role of early brain imaging.

Objective:To summarize prevalence data on the neurologic complications of sickle cell disease (SCD) in Africa.Methods:We searched EMBASE, PubMed, and African Index Medicus to identify all relevant articles published from inception to May 31, 2016. Each study was reviewed for methodologic quality. A random-effects model was used to estimate the prevalence of neurologic complications of SCD across studies.Results:Thirty-one studies were included. Methodologic quality was high or moderate in 90% of studies. Stroke, conditional and abnormal cerebral blood flow, seizures, and headache were the complications most frequently reported, with overall prevalence rates of 4.2%, 10.6%, 6.1%, 4.4%, and 18.9%, respectively. Some complications, like silent brain infarcts, peripheral neuropathies, neurocognitive deficits, or moyamoya disease, have been rarely or not studied at all in the African setting. Incidence data were scarce and of poor quality.Conclusions:The burden of neurologic complications of SCD is important in Africa and most likely underestimated. A better evaluation of this burden requires larger prospective studies using standard up-to-date screening methods. Accessibility to diagnostic tools such as neuroimaging, transcranial Doppler, EEG, and neuropsychological evaluation, as well as to preventive and therapeutic interventions and trained health care providers, should be improved in routine clinical practice.

We read with great interest the article by de Ridder et al1 reporting the results of the PAIS 2 trial (Paracetamol [Acetaminophen] In Stroke 2) that assessed the effect of early treatment with high-dose paracetamol on functional outcome in patients with acute stroke and a body temperature of ≥36.5°C. Some of their findings and conclusions deserve further discussion. The authors found no difference in the number of serious adverse events, including liver failure and infections, between patients treated with paracetamol (n=35 [26%]) and those treated with placebo (n=28 [24%]). Therefore, they concluded that treatment with high-dose paracetamol seemed to be safe as previously demonstrated in the PAIS trial (Paracetamol [Acetaminophen] In Stroke).2 However, although the use of paracetamol above …

Purpose of review Wolbachia is a genus of Gram-negative intracellular bacteria that is naturally found in more than half of all arthropod species. These bacteria cannot only reduce the fitness and the reproductive capacities of arthropod vectors, but also increase their resistance to arthropod-borne viruses (arboviruses). This article reviews the evidence supporting a Wolbachia-based strategy for controlling the transmission of dengue and other arboviral infections. Recent findings Studies conducted 1 year after the field release of Wolbachia-infected mosquitoes in Australia have demonstrated the suppression of dengue virus (DENV) replication in and dissemination by mosquitoes. Recent mathematical models show that this strategy could reduce the transmission of DENV by 70%. Consequently, the WHO is encouraging countries to boost the development and implementation of Wolbachia-based prevention strategies against other arboviral infections. However, the evidence regarding the efficacy of Wolbachia to prevent the transmission of other arboviral infections is still limited to an experimental framework with conflicting results in some cases. There is a need to demonstrate the efficacy of such strategies in the field under various climatic conditions, to select the Wolbachia strain that has the best pathogen interference/spread trade-off, and to continue to build community acceptance. Summary Wolbachia represents a promising tool for controlling the transmission of arboviral infections that needs to be developed further. Long-term environmental monitoring will be necessary for timely detection of potential changes in Wolbachia/vector/virus interactions.

Most studies on sensory extinction have focused on selected patients with subacute and chronic right hemisphere lesions. In studies conducted on acute stroke patients, risk factors and time course were not evaluated. Our aim was to determine the prevalence, risk factors, and time course of sensory extinction in the acute stroke setting. Consecutive patients with acute stroke were tested for tactile, visual, auditory, and auditory-tactile cross-modal extinction, as well as for peripersonal visuospatial neglect (PVN). Tests were repeated at 2, 7, 15, 30, and 90 days after initial examination. A multivariable logistic regression analysis was performed to test the association between sensory extinction and demographic and clinical risk factors. Seventy-three patients (38.4% women) were recruited: 64 with ischemic stroke and nine with haemorrhagic stroke. Mean age was 62.3 years (95% CI 58.8–65.7), mean NIHSS score was 1.6 (95% CI 1.2–2.1), and mean time to first examination was 4.1 days (95% CI 3.5–4.8). The overall prevalence of all subtypes of sensory extinction was 13.7% (95% CI 6.8–23.8). Tactile extinction was the most frequent subtype with a prevalence of 8.2% (95% CI 3.1–17.0). No extinction was found beyond 15 days after the first examination. After adjustment for age, sex, lesion side, type of stroke, time to first examination and stroke severity, a lesion volume ≥2 mL (adjusted OR = 38.88, p = 0.04), and presence of PVN (adjusted OR = 24.27, p = 0.04) were independent predictors of sensory extinction. The insula, the putamen, and the pallidum were the brain regions most frequently involved in patients with sensory extinction. Extinction is a rare and transient phenomenon in patients with minor stroke. The presence of PVN and lesion volume ≥2 mL are independent predictors of sensory extinction in acute stroke. Electronic supplementary material The online version of this article (doi:10.1007/s00702-016-1663-x) contains supplementary material, which is available to authorized users.

Onchocerciasis and lymphatic filariasis (LF) are human filarial diseases belonging to the group of neglected tropical diseases, leading to permanent and long-term disability in infected individuals in the endemic countries such as Africa and India. Microfilaricidal drugs such as ivermectin and albendazole have been used as the standard therapy in filariasis, although their efficacy in eliminating the diseases is not fully established. Anti-Wolbachia therapy employs antibiotics and is a promising approach showing potent macrofilaricidal activity and also prevents embryogenesis. This has translated to clinical benefits resulting in successful eradication of microfilarial burden, thus averting the risk of adverse events from target species as well as those due to co-infection with loiasis. Doxycycline shows potential as an anti-Wolbachia treatment, leading to the death of adult parasitic worms. It is readily available, cheap and safe to use in adult non-pregnant patients. Besides doxycycline, several other potential antibiotics are also being investigated for the treatment of LF and onchocerciasis. This review aims to discuss and summarise recent developments in the use of anti-Wolbachia drugs to treat onchocerciasis and LF.

Introduction Sickle cell disease (SCD) is highly prevalent in Africa. Considered as a public health problem, it is associated with high morbidity and mortality. Neurological complications of SCD can cause significant disability with important socioeconomic and psychological impact on the patients and their families, and can even lead to death if not properly managed. There are important knowledge gaps regarding the burden of neurological complications of SCD in African populations. We propose to conduct the first systematic review to summarise the epidemiological data available on neurological complications of SCD in Africa. Methods and analysis We will search PubMed, MEDLINE, EMBASE and the African Index Medicus from 1 January 1950 to 31 May 2016 for studies of neurological complications of SCD in Africa. After study selection, full-text paper acquisition, data extraction and synthesis, we will assess all studies for quality, risk of bias and heterogeneity. Appropriate methods of meta-analysis will be used to pool prevalence estimates from studies with similar features, globally and in major subgroups. This protocol complies with the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) guidelines. Ethics and dissemination The proposed study will use published data. Therefore, there is no requirement for ethical approval. This review is expected to provide relevant data to help quantify the burden of neurological complications of SCD in African populations, inform policymakers and identify further research topics. The final report of the systematic review will be published in a peer-reviewed journal and presented at conferences. Review registration number CRD42016039574.

We read with great interest the recent article by Tsivgoulis et al1 demonstrating that endovascular thrombectomy (ET) improves the functional outcome of patients with emergent large-vessel occlusion (ELVO) independent of pretreatment with intravenous thrombolysis (IVT). As a consequence, ET could now be viewed as a treatment option on its own and should therefore be considered for patients with acute stroke in the early steps of the management process even if they do not qualify for IVT. This could help to further reduce the time to recanalization which is a key determinant of functional outcome at 3 months.2 Moreover, these results support the current clinical practice of offering ET alone to patients presenting with contraindications to IVT or having a high burden …

Introduction Stroke is the second most common cause of death after ischaemic heart diseases and the third leading cause of disability worldwide. The contribution of cardiac complications to the mortality of patients with stroke is variable across studies, ranging from 12.5% to 22.7%. Many of these cardiac complications are preventable, and early recognition and adequate management guided by appropriate up-to-date knowledge of their relative incidence and fatality can help to improve patients’ outcomes. This systematic review aims to summarise the available data on the burden of cardiac complications after stroke. Methods and analysis This review will include all cross-sectional, case–control and cohort studies and clinical trials published between 1 January 1950 and 31 December 2017, involving adults and/or children, and reporting on the prevalence, the incidence and/or the mortality of cardiac complications after stroke. Two reviewers will independently screen titles and abstracts of records retrieved from PubMed, Excerpta Medica Database, ISI Web of Science and the Cumulative Index to Nursing and Allied Health Literature for eligibility, and then assess the risk of bias and quality of reporting to select the studies which will be included. All authors will contribute to the retrieval of full texts of eligible records and data extraction. Heterogeneity across studies will be evaluated by the χ 2 test on Cochran’s Q statistic. Study-specific estimates of the prevalence, incidence and mortality of cardiac complications after stroke across studies will be pooled through random-effect or fixed-effect meta-analysis depending on the source of the heterogeneity, after stabilising the variance of individual studies using the Freeman-Tukey double arcsine transformation. Visual analysis of funnel plots and Egger’s test will be done to detect small-study effect. Ethics and dissemination This review and meta-analysis will be based on published data and will therefore not require a specific ethical clearance. The results will be published in peer-reviewed journals. PROSPERO registration number CRD42018082551.

IntroductionHeadache disorders (HD) are among the most frequent neurological disorders seen in neurology practice. Because secondary HD are rare, patients’ examination is most often unremarkable. However, the will to relieve patients’ anxiety and the fear of prosecutions lead to overuse of neuroimaging thus resulting in the discovery of incidental findings (IF) or normal variants that can lead to futile or harmful procedures. Knowing the probability of identifying a potentially clinically significant lesion in patients with isolated headache could facilitate decision-making and reduce health costs. This review aims to determine the prevalence of incidental findings and normal anatomic variants (NAV) on neuroimaging studies performed in patients presenting with headache and normal neurological examination.Method and analysisStudies reporting neuroimaging findings in patients with headache and normal neurological examination and published before the 30 September 2017 will be identified by searching PubMed, Medline and EMBASE (Excerpta Medica Database). Relevant unpublished papers and conference proceedings will also be checked. Full texts of eligible studies will then be accessed and data extracted using a standard data extraction sheet. Studies will be assessed for quality and risk of bias. Heterogeneity of studies will be evaluated by the χ2test on Cochrane’s Q statistic. The prevalence of NAV and IF across studies and in relevant subgroups will be estimated by pooling the study-specific estimates using a random-effects meta-analysis. Visual analysis of funnel plot and Egger’s test will be used to detect publication bias. The report of this systematic review will be compliant with the Meta-analysis of Observational Studies in Epidemiology guidelines.Ethics and disseminationThe current study is based on published data; ethical approval is, therefore, not required. The final report of this systematic review will be published in a peer-reviewed journal. Furthermore, findings will be presented at conferences and submitted to relevant health authorities.Trial registration numberCRD42017079714.

Background Soil-transmitted helminthiases (STHs) are among the most prevalent afflictions of the developing world, with approximately 2 billion people infected worldwide. Heavily infected individuals suffer from severe morbidity that can result in death. These parasitic diseases also impair physical and mental growth in childhood, thwart educational advancement, and hinder economic development. Periodic deworming with Albendazole or Mebendazole of high-risk groups (school-age children, preschool children, and pregnant women) can significantly lower the levels of infections below the threshold associated with morbidity. However, an important proportion of the population (adults) is excluded from this high-risk group treatment based-strategy, and might lead to the persistence of these diseases in endemic areas despite the repeated treatments. The main objective of this study was to evaluate the contribution of this neglected at-risk group in the spread and persistence of STH in Cameroon. Methods A cross sectional survey was conducted in the Akonolinga health district (Centre Region, Cameroon) to assess the prevalence and intensity of these helminth infections. Stool samples were collected from males and females, aged 18 years and over, and analyzed using the Kato-Katz technique. Results A total of 334 patients, among which 181 (54.2%) females and 153 (45.8%) males, were examined. The STH of major concern was found in this group of individuals, with overall prevalence equal to 18.0% (95% CI: 14.2–22.4) for Ascaris lumbricoides , 43.7% (95% CI: 38.5–49.1) for Trichuris trichiura , and 7.5% (95% CI: 5.1–10.8) for Necator americanus . Conclusion This study reveals that STH infections are prevalent in adults in the Akonolinga health district, with moderate to high risk and light intensity of infection. These infected adults might constitute a potential parasite reservoir and a source of dissemination and persistence of these infections, highlighting the need to really take into account this neglected group of individuals in the mass treatment policy.

Aim: The study aims to describe the epidemiology and the neural correlates of peripersonal visuospatial neglect (PVN) in patients admitted to the Geneva Stroke Unit for an acute stroke or a transient ischemic attack (TIA). Methods: Eligible subjects were tested for PVN using both the Ota's discriminative cancellation task and a line bisection task. Brain lesions were identified on diffusion-weighted imaging. A multivariate analysis was performed to identify risk factors of PVN. Results: Ninety-eight consecutive patients (40.8% females) were recruited: 64 cases of ischemic stroke, 9 cases of hemorrhagic stroke and 25 cases of TIAs. The mean age was 61.9 ± 2.86 years. The incidence of PVN was 23.5% (95% CI 15.5-33.1) and was not significantly different between patients with right and left hemisphere stroke. There were 5 cases of ipsilesional neglect. There was no association between PVN and age, sex, stroke severity, handedness, lesion type, lesion volume and time to first examination. Lesions of temporal and parietal lobes were the most frequent in patients with PVN. Conclusion: PVN has a low incidence in the acute stroke settings and there is no particular predictor of its presence. It is most often associated with temporo-parietal lesions.

Introduction Des symptomes neurologiques transitoires ou permanents sont presents chez 17 &#8211 ; 40 % des patients ayant une dissection aortique, ce qui peut entrainer des errances diagnostiques. Observation Nous presentons le cas d’un caucasien de 44 ans ayant consulte pour des hemicrânies droites recurrentes et stereotypees. L’examen clinique et l’IRM cerebrale etaient normaux. L’hypothese d’une dissection aortique a ete evoquee en raison de la presence d’une douleur thoracique sourde associee. Le scanner thoraco-abdominal avec produit de contraste a permis de confirmer ce diagnostic en mettant en evidence une dissection aortique type A. Le patient a beneficie d’un remplacement en urgence de l’aorte ascendante et aucun episode de cephalee n’a ete rapporte apres l’intervention. Le diagnostic differentiel des cephalees dans ce cas comportait les cephalees trigemino-dysautonomiques (hemicrânie paroxystique, algie vasculaire de la face et SUNCT), la migraine et la nevralgie du trijumeau. Toutefois, le fait que les criteres diagnostiques n’etaient remplis pour aucune de ces cephalees primaires et la disparition des cephalees apres le traitement chirurgical nous ont conduits a emettre l’hypothese que les hemicrânies recurrentes de notre patient etaient symptomatiques de la dissection aortique. Discussion Nous emettons l’hypothese que l’ischemie de la paroi aortique a entraine une activation pathologique du systeme trigemino-vasculaire responsable des douleurs hemicrâniennes. Cette activation du systeme trigemino-vasculaire serait possible a travers deux voies : une voie anatomique/anastomotique et une voie humorale. Conclusion Les neurologues doivent considerer le diagnostic de dissection aortique en cas de cephalees aigues associees a des douleurs thoraciques. Des travaux complementaires sont necessaires pour valider les hypotheses presentees.

Sinusitis is a frequent and very often under-diagnosed condition. Despite the constantly increasing number of antibiotics with improved efficacy, prevention of its complications remains difficult. The prevalence of these complications is estimated at 3.7%. Their clinical presentation is highly variable making the diagnosis difficult and thereby increasing mortality. In this article, historical, epidemiological, pathophysiological, clinical and therapeutic aspects of neuro-ophthalmological complications of sinusitis are reviewed. For didactic reasons, the various complications have been divided into extra-axial, intra-axial, vascular, and orbital. Specific paragraph have been devoted to sinusitis-related bone complications and pain syndromes. It's however obvious that various more or less complex associations of these complications can be seen in daily practice.

A 75-year-old woman with unremarkable medical history, consulted for a 5-month history of involuntary shaking of left upper limb. Clinical examination revealed polyminimyoclonus of the upper limbs with cogwheel-like rigidity, hyperreflexia, bradykinesia, inconstant spastic-like rigidity in the lower limbs and a stiff and cautious gait. These symptoms, together with the memory impairment found on neuropsychological assessment yielded suspicion for a subacute encephalopathy probably due to a non-conventional infectious agent. There was no 14-3-3 protein found in the cerebrospinal fluid and no periodic sharp wave complexes on EEG. These findings made the diagnosis of Creutzfeldt-Jakob disease (CJD) rather unlikely according to the current WHO diagnostic criteria. However, typical isolated cortical hyperintensity of right temporal, parietal and occipital lobes on MRI suggested a probable CJD and prompted cerebral biopsy which confirmed the diagnosis. This article emphasises the need to update the current WHO criteria by including radiological findings.

Editors' Note: In WriteClick this week, Dr. Tenser, referencing “A dual concurrent mechanism explains trigeminal neuralgia in patients with multiple sclerosis,” argues that vascular compression has been overemphasized as an etiology in trigeminal neuralgia (TN) and hypothesizes a CNS etiology. Authors Truini and Cruccu disagree with his reasoning and reemphasize the importance of root entry zone demyelination in pathogenesis. In reference to “Neurologic signs and symptoms frequently manifest in acute HIV infection,” Drs. Kamtchum-Tatuene et al. and authors Hellmuth et al. agree that neurologic symptoms in acute HIV infection are typically mild and possibly underestimated. Both groups stress the importance of timely HIV diagnosis …