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Background: Encephalitis of Rasmussen is an inflammatory hemiencephalopathy of unknown etiology. It is a cause of drug-resistant epilepsy. Aim: To report two cases of Rasmussen’s encephalitis (RE) in a low-income setting. Clinical Observation: The cases concerned were that of an 8-year-old boy and a 4-year-old girl. The illness began with daily several seizures at the age of 28 months in the boy and 23 months for the girl. Epileptic seizures were generalized in the elder one and focal in the younger. The elder presented right hemiplegia with severe cognitive impairment. In the younger child, the expression of the language was disturbed, associated with right hemiparesis at 4/5. The electroencephalography recording showed background theta asymmetric rhythm associated with discharges of periodic lateralized epileptiform discharges (PLEDs) into the left hemisphere in the two cases. Brain imaging showed left hemisphere atrophy. The seizures had decreased in intensity after association of several anticonvulsant molecules over a period of 3–6 months. The diagnosis of RE was based on clinical, paraclinical, therapeutic, and evolution arguments. Conclusion: There was a delay to establish the diagnosis. Further studies are needed to evaluate rehabilitation capacities in children with RE before brain maturation.

Background Streptococcus suis is a zoonotic pathogen which represents the leading cause of meningitis in Southeast Asia and an emerging pathogen in the Western world, the main risk factor for infection being contact with pigs. In Africa, the prevalence of S. suis infections in swine and humans is largely unrecognized, with only one recent report of a limited case series. Case presentation We describe a human case of meningitis due to S. suis in a 32-year-old man living in Togo. The patient had no particular medical history and no risk factors for immunodeficiency but reported regular contact with pork products. Using specific immunological and molecular methods, we characterized the isolate as S. suis serotype 2, ST1, one the most prevalent and virulent clone worldwide. The outcome was favorable after one week of adapted antibiotic therapy but the patient was left with severe hearing disorders. Conclusions This work highlights the emergence of this pathogen in Africa and reinforces the need for accurate epidemiological and surveillance studies of S. suis infections and for educating clinicians and exposed groups in non-endemic countries.

Forestier’s disease or ankylosing hyperostosis is a non inflammatory esthesopathy that ossifying the anterolateral spine face and sparing the disc and joint space. It is often occurred in elderly men over 50 years old. We aimed to report an early onset Forestier’s Disease in a 20- year –old student. He was admitted for walking trouble, decline hearing and speech disturbance that began progressively four years ago. The neurological examination let appear walking ataxia, slight amyotrophy of both legs and deep sensibility impairment. Somatic exam has revealed the outgrowth bones areas. Ophthalmic examination has noted decreased visual acuity less than 4/10th in both eyes. The audiogram has showed bilateral decline in hearing. X-ray showed an anterior weaving hyperostosis in spine, multiple new bones formation in joints of skull, mandible, scapula, humerus and knees.

L'epilepsie est particulierement frequente dans les pays en developpement (PED) ou le hiatus therapeutique (treatment gap) reste eleve malgre la disponibilite des medicaments antiepileptiques (MAE) efficaces et peu couteux tels que le phenobarbital. Les considerations socioculturelles expliquent cette situation de rejet et de prejuges.ObjectifEtudier les donnees anthropologiques, culturelles et psychosociales de l'epilepsie au Togo et apprecier leur evolution.Materiel et methodeNous avons realise une etude retrospective portant sur l'epilepsie depuis 25 ans au Togo. Les differentes enquetes realisees dans trois grandes aires culturelles du Togo ont concerne trois groupes de personnes : les depositaires du savoir collectif, la population generale (1 668 dont 50 % etaient scolarises) et le personnel soignant (180). Les questions ouvertes concernaient les connaissances et les comportements face a l'epilepsie.ResultatsL'epilepsie est consideree comme surnaturelle, contagieuse et incurable par les trois groupes etudies. Cette mauvaise connaissance de l'epilepsie semble expliquer les attitudes de stigmatisation de l'epileptique. Cependant, certains aspects rationnels de l'affection sont connus des depositaires du savoir collectif et surtout des patients les plus instruits. En parallele, ces derniers ont signale des attitudes et des pratiques favorables a la prise en charge de l'epileptique.ConclusionLe Togo n'echappe pas aux croyances populaires erronees concernant l'epilepsie. Les attitudes et les comportements qui en decoulent sont parfois plus nefastes a la personne epileptique que la maladie elle-meme. Une evolution positive parait possible en fonction d'une amelioration du niveau d'instruction et de la mise en place d'un programme d'education sanitaire et de soins primaires.

Introduction Les AVC constituent un probleme de sante publique et defient les systemes de sante. Nous rapportons un cas d’infarctus cerebral revelant une tuberculose. Observation Un sous-officier de 41 ans, droitier, hypertendu neglige fut transfere dans le service de neurologie le 11 novembre 2014 pour un deficit hemicorporel gauche survenu 48 heures plus tot. L’examen avait permis de retrouver un patient comateux, une febricule a 38 °C, un Glasgow a 7/15 associe a une hemiplegie gauche flasque, une heminegligence visiospatiale et une hypoesthesie ipsilaterale. Le scanner cerebral montra une lesion au territoire Sylvien total droit. L’ECG etait sinusal avec une hypertrophie ventriculaire gauche. La radiographie pulmonaire fut normale de meme que l’EDTSA. La NFP etait normale et la VS a 120 a la premiere heure. On decouvre une hyperglycemie 3,80 g/L avec une HbA1 C a 13 %. La fonction renale etait normale de meme que le bilan hepatique. Les serologies VIH, HVC et HVB etaient revenues normales. Le bilan lipidique fut perturbe avec une predominance sur la fraction LDL. On realisa une PL qui ramena 16 globules blancs avec 78 % de lymphocytes. La proteinorachie est elevee a 1,80 g/dL avec une glucorrachie basse a 0,45 g/dL. La culture du LCR se revela positive avec presence de BK. Le patient beneficia d’un traitement antithrombotique et d’une quadri-antibiotherapie antituberculeuse selon le protocole national en vigueur. Si le retour a la conscience fut normal, en revanche, la fonction motrice n’a pas ete recuperee. A un an de reeducation fonctionnelle, le patient marche avec une canne et est tres spastique. Discussion Le role du BK comme facteur de risque neurovasculaire est discutable. Le diabete pourrait etre considere comme l’element favorisant cet evenement vasculaire. En tout etat de cause, la recherche d’un syndrome inflammatoire biologique devant tout processus vasculaire doit etre la hantise de tout medecin exercant sous les tropiques dans ce contexte de transition epidemiologique. Conclusion Si les AVC constituent un reel probleme de sante publique, leur association avec les maladies transmissibles doit etre recherchee.

Background: Amyotrophic lateral sclerosis (ALS) is a degenerative motor neuron disease. It evolves to loss of autonomy and death. Objective: To describe the cases of ALS clinically definite observed in hospital field. Patients and methods: The retrospective study has covered a period of 10 years (2003-2012) and a total of 10,128 patient’s files were analyzed. The neurology department of our level 3 hospital has located the current study. Six patients with no particular medical history have been reported. The inclusion patients are cases where the diagnosis of ALS was clinically definite according to the modified El Escorial classification. About 978 of likely, possible and probable cases of ALS were not included. Results: The mean age was 49 years (24 and 67), all males, with a frequency of 0.59 ‰ and an incidence rate of 0.6 cases per year. The clinical signs were marked by the pyramidal syndrome and peripheral neuropathic motor syndrome. MRI or CT scan signs were marked by the bulbar light atrophy. EMG had shown spontaneous activities with reinnervation signs. The histology exam has found neurogenic fascicular atrophy. The average duration of progression of the disease from the diagnostic to death was 17.6 months (6 to 36). The median of survival all cases combined was 42 weeks. Symptomatic treatment was associated to rehabilitation. Riluzole has been established despite its high cost, but without success. Conclusion: This observation highlighted the major difficulties encountered in the management of ALS and its increasing frequency in south Saharan Africa.

Background: Stroke is the leading cause of permanent disability acquired in the world. Aim: To study the epidemiological indices, risk factors and outcome of stroke. Subjects and Methods: It was a prospective study to collect epidemiological data, clinical presentation and outcome of stroke patients in 28 public and private health facilities in our largest health region. It had covered the period from January to December 2013. Results: A total of 43,558 inpatients were enrolled. Among them, 986 patients had a stroke which frequency was 2.26 %. The incidence rate has been estimated to 79.58/ 100,000 inhabitants/year. Male subjects were observed in 50.8% and 49.2% of females. The mean age was 59 ± 13.2 years. Concerning the stroke subtype, ischemic stroke was found with 54.9% and 45.1% of hemorrhagic including 10.8 % of subarachnoid hemorrhage. The traditional main risk factors were hypertension (87.3 %) and diabetes (17.5 %). The mean time of admission was 55 ± 20.75 hours. The average time before beginning first care was 56 ± 20.74 hours. Only 44% of patients had received first aids within 24 hours. The average length of stay was 17 ± 8.5 days. The mean modified Rankin scale score at the exit time was 2.3 ± 0.8. At discharge, 58.9% of patient had partial motor deficits and 27.5% of them died. Conclusion: A good knowledge of risk factors and early signs of stroke by the population will reduce stroke mortality and its functional sequel. All these lacks of assessment increase the delay in the management of patient and lead to permanent deficits.

Background and purpose: The thalamic infarct is frequent among ischemic stroke. We aim to determine the frequency of the thalamic infarct and analyze the different arterial territories affected in patients with thalamic syndrome. Patients and Methods: It was a prospective study. It focused on patients hospitalized in the neurology department of our university hospital, and covered the period from January to December, 2012. Only inpatients respondents to clinical and radiological criteria for diagnosis of thalamic ischemic stroke were included. All were evaluated with detailed clinical and neuropsychological evaluation, computer tomography scan (CT scan), routine blood studies, electrocardiogram, and transthoracic echocardiography. All standard risk factors were recorded in these patients. Results: A total of 768 files were analyzed of which 219 cases of cerebral infarction were selected. Among them, 12 patients had lesions involved only thalamic nuclei, which giving the frequency of 5.48%. The mean age was 59.33 years old with a ratio sex of 1.7. The clinical signs most observed were motor deficits (8/12), speech disturbances and anterograde memory impairment (7/12), and. sensory loss (5 cases). The high blood pressure was the main risk factor in all patients. The left thalamic ischemia was most frequent with 7/12 cases. The arterial territories affected were formed by the thalamotuberal arteries in 5/12, thalamoperforating arteries, (4/12), thalamogeniculate arteries, (3/12) and posterior choroidal arteries in 2/12, giving fourteen lesions. Conclusion: Thalamic infarct solely is not so rare and all its arterial branches may be affected. The sensory deficits and abnormal involuntary movement remain the embarrassing and difficult symptom to manage.