Introduction Hydranencephaly is a rare malformation of the cerebral system resulting from the absence of development of the cerebral hemispheres which are replaced by pockets containing cerebrospinal fluid. The objective of our work was to assess the epidemiological, clinical, therapeutic aspects, complications and postoperative follow-up in our practice conditions. Materials and methods This is a retrospective study over 3 years (from January 1, 2019 to December 31, 2021) on 51 patients admitted to the neurosurgery department of the CHU of Fann for management of hydranencephaly. Results The mean age of the patients was 6.24 months [25 days-19 months], with a female predominance (51%). A history of consanguinity was found in 41% of the cases, and a good follow-up of the pregnancy with periconceptional folic acid supplementation in 78% of the cases. The mode of delivery was vaginal delivery (62%) and caesarean section (29%) with 2 cases of prematurity. The reason for consultation was macrocrania in all our patients. Intracranial hypertension was present in 70%; there were 3 cases of associated malformations such as spina bifida; the average cranial perimeter was 57.7 cm [47-76 cm]. CT scans were performed in all patients. 96% of them benefited from a ventricular peritoneal shunt with 27% of cases of postoperative meningitis and 3 cases of death. Regular follow-up was performed in 43% of the patients, ranging from 1 month to 21 months. In addition, 51% were lost to follow-up. Conclusion Hydranencephaly is a serious cerebral malformation which poses a problem of differential diagnosis with major hydrocephalus whose differential diagnosis is made with the electroencephalogram. The diagnosis can be made antenatally with ultrasound but relies on CT scan postnatally. Management is based on peritoneal ventricular shunt.
Objective To define the place of empiric anti-tuberculosis treatment in deep intracerebral lesions in a tuberculosis endemic area. Materials and Methods We performed a retrospective descriptive study in the neurosurgery department of the Grand Yoff General Hospital over a 4-year period from January 2014 to December 2017. All patients managed for an intracranial expansive process who responded well to anti-tuberculosis chemotherapy were included in our study. We studied the clinico-radiological epidemiological data and their evolution under treatment. Results From January 2014 to December 2017 in the Neurosurgery Department of Grand Yoff General Hospital, 5 cases of intracranial tuberculoma were identified with a mean age of 43 years and a sex ratio of 0.25. We did not find any notion of tuberculosis infection in our patients. Immunodepression was noted in 3 patients. The different clinical manifestations were an intracranial hypertension syndrome (4 patients), hemiplegia (4 patients) and impaired consciousness (3 patients). Neuroimaging revealed a deep heterogeneous lesion with high edema in 4 cases and in one case multiple disseminated lesions above and below the tentorial level with metastatic appearance. A thoracic-abdominal-pelvic CT scan requested in all patients was normal. In view of the epidemiological, clinico-radiological arguments, a trial anti-tuberculosis treatment was instituted in all patients with a good outcome in all cases. A sequellar hemiparesis was noted in one patient despite the complete disappearance of the lesion on the brain scan after one year of treatment. Conclusion In front of the unavailability of stereotaxis, the antituberculosis trial treatment keeps its place and should be started in front of any heterogeneous deep intracerebral lesion.
Intraoperative brain mapping techniques allows managing diffuse low-grade gliomas often located in a functional area, which were once considered inoperable. This technique commonly practiced in developed countries, was not practiced in French speaking sub-Saharan Africa. We report our first experience of removing of a low-grade glioma in awake surgery. Case presentation A 34-year-old patient presented with partial seizures. Neurological examination revealed the presence of a pyramidal syndrome with right-side hemiparesis at 4/5. The MRI showed a left precentral tumor-like lesion with a heterogeneous contrast enhancement. A biopsy under neuronavigation was performed. Anatomopathological examination confirmed a grade II gemistocytic astrocytoma. After a multidisciplinary meeting, a decision of near complete resection was taken. The resection of the tumor was performed in awake surgery according to the AAA (Asleep-Awake-Asleep) anesthetic protocol. During the first postoperative day, the MRI showed subtotal resection (STR) of more than 80%. The patient was discharged without any neurological deficit. The 6-month follow-up did not reveal any incidence of seizures. Conclusion Diffuse low-grade gliomas surgeries should no longer be limited by the choice between function preservation and patient survival, but rather should now be more ambitious and try to have a positive influence on both. Intraoperative brain mapping during awake surgery provides this objective which is now possible in Abidjan.
Background This study aims to retrospectively review the data of patient's risk factors, clinical patterns, and outcomes of the stroke in a tertiary care hospital of central Africa, democratic republic of Congo (DRC). Methods We carried out a retrospective study of all the patients who had a clinical diagnosis of stroke with neurological deficit and pointing to a vascular cause as confirmed by computerized tomography (CT) or magnetic resonance imaging (MRI) brain. This study was conducted at private tertiary care hospital which is a public-private partnership run hospital in Kinshasa, DRC. Result A total of 1021 patients reviewed in the department of neurology were studied of whom 6.86% (70 patients) of neurological visits were attributed to stroke in that period. The mean age of the patients was 55 years. Males accounted for 67.1% of the cases and the rest were females. Out of these patients, 33(47.14%) belonged to the high socio-economic class while 37 (52.86%) belonged to the low class. The overall prevalence of stroke was found to be 6.86%. Ischemic stroke was significantly more frequent ( 94.3%) than haemorrhagic. Hypertension, higher alcohol intake, smoking, obesity, and dyslipidaemia were significant risk factors of stroke in an African population. Small vessel strokes were more frequent in this population. Conclusion This paper highlights the epidemiology of stroke in central Africa.
Background Craniopharyngiomas are rare benign epithelial tumours that develop in the sellar and suprasellar region. The often intimate relationships of the tumour with delicate neurovascular structures and the frequent absence of a cleavage plane prompted neurosurgeons to seek less aggressive approaches as an alternative to surgical excision. The transcortical transventricular neuroendoscopic approach represents an interesting option for cystic or predominantly cystic forms, which represent the majority of craniopharyngiomas. Case presentation We report the case of a 4-year-old girl who was brought into the emergency room with signs of severe intracranial hypertension. Brain magnetic resonance imaging (MRI) showed a large cystic lesion of the sellar and suprasellar region compressing and occupying the third ventricle with bi-ventricular hydrocephalus. The patient was urgently treated by transventricular endoscopy with draining of the cyst and extensive marsupialisation in the ventricle. The contents of the cyst were yellowish, oily and filled with shiny fragments. The postoperative course was marked by a good improvement in clinical symptoms. The control MRI at 27 months showed sagging of the cyst with significant reduction in its size. Conclusion In this case, the pure transventricular neuroendoscopic approach was simple and safe with good long-term results.
Background The blink reflex (Blink Reflex) is a non-invasive electrophysiological exploration technique. It allows to study the proximal conduction of the facial and trigeminal nerves. In addition, it also allows to explore the brainstem. Objective The objective of our study was to establish the normative values of the blink reflex at the neurophysiology laboratory of the Fann National University Hospital Center in Dakar-Senegal. Methodology The study population consisted of 30 healthy adult subjects who volunteered to participate in the study, ranging in age from 18 to 59 years old. This was a cross-sectional study, over a period of two months, from March 1st to April 30th, 2019.The electromyography machine used was a Medelec Synergy (OXFORD) device. The recording of the blink reflex allowed to obtain an early R1i (ipsilateral) response and two late responses, R2i and R2c which was contralateral. Results The mean latency of the R1 response was 10.7 +/- 4 ms with extremes between 9.9 ms and 11.8 ms. The mean latency of the R2 response was 33.3 +/- 3.3 ms with a minimum at 26 ms and a maximum of 40 ms. The mean response latency R2c (contralateral) was 33.5 +/- 3.6 ms with a minimum of 27 ms and a maximum of 41 ms. Conclusion Our work shows average latencies: R1 at 10.7ms, R2 at 33.3ms and R2c at 33.5ms.
Objectives The anterior approach to the cervical spine has been considered the gold standard for cervical disc herniation surgery for decades. The aim of this work was to study the epidemiological, diagnostic and therapeutic aspects and to evaluate the short and long term results of cervical discectomy with and without grafting in Dakar. Materials and methods This was a retrospective study of patients who underwent anterior approach surgery for cervical disc herniation, collected at the neurosurgery clinic of the CHNU of Fann in Dakar, extending over a period of three years, from 1 January 2019 to 31 December 2021. Seventy-eight patients were operated on from 91 levels. The hernia concerned a single level in 83.3% of cases (n=65) and was staged, limited to two levels in 16.7% of cases (n=13). Thirty-five patients had a simple discectomy on 35 levels (38.5%), and 43 patients had a complementary arthrodesis on 56 levels (61.5%). Results The results of this study show that the postoperative results are satisfactory over time, with a follow-up period ranging from six to twelve months. Thus, we noted 91.4% good results in the group with simple discectomy and 93% in the group with discectomy plus graft. We noted 11.5% of postoperative complications and overlying and underlying pain was found in 7 of the patients and 5 of these patients were operated on for grafting. Conclusion The retrospective monocentric study shows insufficient hindsight to judge the long-term consequences of the changes observed radiologically. The results are in agreement with the literature and show that anterior disc surgery allowing a simple discectomy or associated with a segmental arthrodesis can give good results.
Introduction Modern neurosurgery was introduced and started to develop in African countries from 1951. In Cote d'Ivoire, there is no data in the literature on the history of neurosurgery. Objective To provide a history of neurosurgery in Cote d'Ivoire Methods Retro-prospective cross-sectional study with a descriptive aim of the evolution of neurosurgery in Cote d'Ivoire from the first practices to the present day, based on a survey, a literature review and interviews. Results Four periods were identified. The first, which began in 1972, is identified with Doctor Melaine Kouame KANGAH, the first neurosurgeon. Craniocerebral traumatic pathology and meningiomas were then treated. The second period extended from the opening of the Neurosurgery Department of Yopougon in Abidjan in 1990 until 1998. Professors Jean Jacques SANTINI, Vincent BA ZEZE, "father" of Ivorian neurosurgery, Gilbert DECHAMBENOIT and Guy VARLET marked this period which saw the development of Ivorian neurosurgery. Then the third period of stagnation, until 2012, which however saw the diversification of skills, the opening of the Diploma of Specialized Studies in 2007, the creation of a pediatric unit in 2008, and the Ivorian Society of Neurosurgery in 2009. The fourth period was characterised by the resumption of progress in terms of human and material resources, with the opening of the Bouake and Yamoussoukro services, and the development of private practice. But much remains to be done in terms of equipment and training. Conclusion Notable progress has been made in this study. The prospects are summarised in the project to create an institute of neuroscience and other neurosurgery services in the major regions of the country.
Objective The aim was to measure the dimensions of the labyrinthine segment of the facial canal and the geniculate ganglion fossa, through high-resolution computed tomography, which allows thinner slices of the petrous bones, and by using a wider working sample. Materials and Methods We used computed tomography slices of 194 healthy adult petrous bones randomly selected. The CT-Scan machine was of 128 slices. We measured the length (mm) and the diameter (mm), and we determined their means, standard deviations and ranges. The paired Student t-test was used to compare the means according to the gender and the side. Results The mean length of the LSFC was 2.70 mm +/- 0.54 (range 1.54 - 4.48 mm), with no significant difference between male and female (p = 0.52 and p = 0.33) or right-left (p = 0.23). His mean diameter was 0.97 mm +/- 0.35 (range 0.44 - 2.19 mm), with no significant difference between male and female (p = 1.1 and p = 0.37) or right-left (p = 0.65).For the GGF, the mean length was 2.87 mm +/- 0.59 (range 1.47 - 5.10 mm), with no significant male-female difference (p = 0.94 and p = 0.68) or right-left (p = 0.49). The mean diameter was 2.07 mm +/- 0.42 (range 0.96 - 3.96 mm). We had a male-female significant difference for the diameter on the left (p = 0.01). Conclusion We provide a contribution to the knowledge of the morphometry of the LSFC and the GGF.
IntroductionThe role of cobalt, a prosthetic group of cobalamins and factor of cyanide detoxification, has not yet been clarified in konzo and related disorders. The objective of this study was to elucidate the relationship between cobalt, oxidative stress and cognitive impairments in children living in konzo affected area.MethodsWe used a cross-sectional study that included 21 children with konzo (CWK) and 19 presumed healthy (PHC). Serum levels of oxidative stress marker F2-isoprostanes and metallic trace elements were determined respectively by High Performance Liquid Chromatography and spectral analysis and by Inductively Coupled Plasma Mass Spectrometry. Cognitive performance was assessed by Kaufman Assessment Battery for Children, 2nd edition. Statistical analysis was done with SPSS 21 software.ResultsNo difference was found in serum cobalt levels between CWK and PHC. Oxidative stress was higher and cognitive performance lower in CWK (p <0.05). Normal serum cobalt levels were associated with reduced oxidative stress (13 = 0.363, 95% CI: 0.053 to 0.778; p = 0.049), higher cognitive performance in learning (13 = 20.360; 95% CI %: 5.393-35.327; p = 010) and recall memory (13 = 23.082; 95% CI 5.393-35.327; p = 0.007).ConclusionOxidative stress and cognitive disorders in children living in area affected with konzo involve metabolism related to cobalt.
Background The aim of this study was to assess surgical risk in meningioma surgery using the CLASS scale designed by Joung H. Lee and Burak Sade at Mali Hospital. Method A retrospective study of medical file was performed of all patients operated from intracranial meningioma between 2011 and 2015. We analyzed the surgical outcome using the Glasgow outcome Scale at six weeks. CLASS scale which classified the patient risk at surgery in low, mild and severe according mainly to five criteria: comorbidity, location, age, size, signs and symptoms. Medical and neurological complications were recorded. Results Sixty-one patients were included in this study. Sex distribution was 36 females and 25 males. Mean age was 44.78 years. At six weeks of surgery 77% of patients were good Glasgow Outcome and 23% were bad. We found 16 medical complications in 14 patients and 8 neurological complications in 8 patients. Conclusion The CLASS algorithmic scale is a good mean for patient selection in meningioma surgery because it's simple, easily reproducible and applicable at all patients independently of age and location of tumor. It may represent a helping tool above all young neurosurgeon.
Description Chorea is one of the hyperkinetic abnormal movements' syndromes with a prevalence of 5% of all abnormal movements. The etiologies are multiple and dominated by Sydenham's chorea in underdeveloped countries. Purpose The objective of our study was to characterize the epidemiological, clinical, paraclinical, etiological, therapeutic and evolutionary aspects of children followed for Sydenham's chorea at the pediatric neurology unit of the Albert Royer National Children's Hospital. Patients and methods This was a retrospective and descriptive study from January 2005 to January 2019 which took place at the pediatric neurology unit of the Albert Royer National Children's Hospital in children diagnosed with Sydenham's chorea and whose age was less than or equal to 16 years. Results Within 14 years, we have collected 11 children diagnosed with Sydenham's chorea including 8 girls and an average age of 9.45 years. The extra neurological signs were rheumatic heart disease and arthralgia. All patients received neuroleptic (haloperidol) and the outcome was favorable in 90.90% of the children. Conclusion Chorea represent an uncommon symptomatology in our context Sydenham's chorea is the most common form of acute infectious chorea in children. Treatment with haloperidol remains effective in the symptomatic treatment of these choreas.
Background and purpose Neurology is the medical specialty that studies diseases of the nervous system (central and peripheral). In Senegal, it was for a long time confined to Dakar. The advent of the UFR Sant & eacute; has favored the establishment of a neurology consultation at the Tivaouane hospital since 2014. The objective of our work was to present the results of this activity after almost four years. Method From the consultation register, we collected and analyzed the socio-demographic data and the reasons for consulting patients between April 2014 and January 2018. 1112 patients were consulted during the period, 59% of whom were women. The most representative age group was 35-70 years old with 47.9%. The main reasons for consultation were represented by lumbosciatalgia (25%), seizures (11.2%), headaches (9.3%), hemiplegia (5.5%), paresthesias (5%), low back pain 2.5%, parkinsonian syndrome (1.8%), neck pain (1.7%), dizziness (1.3%). Discussion and Conclusion Our results therefore show that there is a great diversity of reasons neurological consultation in Tivaouane for patients who, for the most part, are young adults. They also allow us to have, initially, a panoramic vision of the reasons for consultation and, secondly, to consider targeted studies, in particular for the most frequent reasons such as lumbosciatalgia, seizures and headaches for example.
Introduction Non-tumoral stenosis of the foramen of Monro is a rare anatomoclinical entity which causes asymmetric hydrocephalus of the lateral ventricles when the stenosis concerns a single foramen or biventricular dilation when it is bilateral. The objective of this work is to report the efficacy of neuroendoscopic surgery in the treatment of this pathology. Method We report two observations of non-tumoral stenosis of Monro's foramen. Both patients underwent endoscopic treatment with a foraminoplasty completed by endoscopic third ventriculostomy. The postoperative follow-up was straightforward with clinical improvement. Discussion Monro's foramen stenosis is a rare condition. Its pathogenic mechanism is poorly understood. Cerebral MRI can be used to diagnose and rule out a tumor origin of the stenosis. Cerebral endoscopy allows better visualization of the stenosis as well as the associated intraventricular malformations. It also allows for the performance of foraminoplasty with endoscopic third ventriculostomy. Conclusion Non-tumoral stenosis of the foramen of monro is an uncommon condition. The clinical expression is that of intracranial hypertension. Its diagnosis is suggested on cerebral MRI. Intraventricular endoscopy confirms the non- tumoral etiology of the stenosis and allows treatment of hydrocephalus by reestablishing the CSF outflow pathways.
Surgical decompression of the median nerve at the carpal tunnel is one of the most common surgical procedures in hand surgery. This nerve decompression is most often performed under non-adrenalized local anesthesia and with a tourniquet. The purpose of our work was to present two cases of surgical decompression of the median nerve at the carpal tunnel without tourniquet with adrenalized lidocaine infiltration and to review the literature. It appears from this review that decompression of the median nerve at the carpal tunnel without tourniquet with adrenaline lidocaine infiltration can be safely performed
Background: Epilepsy remains in certain African populations a disease with myths and discriminatory socio-cultural interpretations. Aim: To assess the level of knowledge, attitude and practice of the population about epilepsy in a semi-urban setting (Djougou) in Benin in 2019. Methods: Descriptive analytical cross-sectional study with data collection from August 28 to September 29, 2019 in a face-to-face interview, which included subjects aged 15 years and older, residing in Djougou for at least 6 months, who gave their free and informed consent. The sampling was probability based with a two-stage cluster survey. The level of knowledge and attitude-practice was defined by two respective scores with two levels of appreciation (bad or good). Associated factors were determined after logistic regression. Results: 180 subjects were interviewed, of whom 111 were men (sex ratio 1.6). The median age was 26 years [16-85 years]. The level of knowledge was good in 6.11%; CI95% [3.09% - 10.67%]. 43.33% had good attitude and practice about epilepsy, CI95% [35.98% - 50.91]. Factors associated with good knowledge were age (p=0.03), occupation (p=0.009), religion (p=0.01), source of information (p=0.000). Good attitude and practice was associated with sex (RP = 1.42; IC95% 1.0 - 2.04), socioeconomic level (p=0.01), good knowledge of epilepsy (p=0.02). Conclusion: In Djougou, the population had a poor level of knowledge and attitude-practice about epilepsy. Targeted education and awareness campaigns are essential to bring epilepsy out of the shadows.
Purpose To remind spine local skin marks suggestive of a dermal sinus tract and to highlight the importance of early prophylactic excision of this lesion. Methods: Data from the medical records of three patients admitted for the management of a dermal sinus tract associated with a central nervous system infection were reviewed. Results: Two patients were male and one female aged of 11 months, 3 years and 11 months respectively. Presenting symptoms were neurological deficits with fever in two cases and recurrent meningitis in one case. MRI was suggestive of intradural abscess at the lumbar vertebral level with a dermal sinus tract in all cases. The abscess was drained and the tract was surgically excised. Neurological deficits remained in two cases. Conclusion: To avoid catastrophic neurologic consequences due to the infectious complications of a dermal sinus tract, this malformation must be detected by every pediatrician examining an infant, and early prophylactic surgery is obligatory.
Introduction The encephalic complications of sinusitis have been exceptional since the advent of antibiotics, but extremely serious given the proximity of the brain. Despite the popularization of antibiotic therapy, post-sinus encephalic complications occur in a context of untreated chronic sinusitis. We report a series of cases observed at Yaounde General Hospital. Methods We report a series of eleven patients hospitalized for infection secondary to sinusitis at Yaounde General Hospital between 2015 to 2017. The objective of this descriptive and prospective work was to report the clinical, paraclinical and evolutionary aspects of encephalic complications due to infectious sinusitis observed in our context. Results Our series included 11 patients. All had performed brain imaging (CT scan or magnetic resonance imaging) which revealed 5 cases of brain abscesses, subdural and interhemispheric empyemas, 2 cases of cerebral venous thrombosis and 2 cases of diffuse encephalitis. All of our patients had a negative HIV serology. The outcome was favorable for 8 patients, but we observed 3 postoperative deaths. Among the cured patients, 4 of them presented with motor sequelae. Conclusion The encephalic complications of sinusitis, although exceptional, are fatal. The earliest possible diagnosis associated with adequate management and follow-up allows a favorable outcome.
Introduction: Publications on childhood strokes are relatively rare in Africa while the main etiological factors reported in the literature are present on the continent. This study aimed at defining the risk factors, clinical and paraclinical aspects of stroke in children in Dakar (Senegal). Methods: It was a restrospective multicenter study in the pediatric departments of Dakar university hospitals (Fann, Diamniadio and Albert Royer) between January 2005 and January 2020 of children aged 2 months to 18 years. Results: We collected 240 cases of stroke including 201 cases of ischemia and 39 cases of hemorrhage. The mean age was 60 months. Clinical manifestations were predominantly hemiplegia (33.33%) and signs of raised intracranial pressure (20.51%) for hemorrhagic strokes. In ischemic stroke, hemiplegia (79.60%) and seizures (18.05%) were predominant. The middle cerebral artery was the most affected (63.68%) in ischemic strokes. Supratentorial hemorrhagic attacks represented 94.8% and infratentorial attacks 5.12%. The main factors were sickle cell disease and heart diseases for ischemic strokes; vascular malformations for hemorrhagic strokes. Conclusion: Child stroke remains common in children with modifiable risk factors. The frequency of sickle cell disease and vascular malformations testify the need for multidisciplinary collaboration for better care of children.
Haematidrosis is a disorder of sweat secretion characterized by the presence of red blood cells, leukocytes and platelets in the sweat. Its potential triggering factors are the occurrence of an episode of intense emotional stress or the presence during a traumatic event. It can be associated with paroxysmal stereotypical clinical manifestations that can simulate epileptic seizures. We report the case of a young adolescent girl, followed for a long time for epileptic seizures, in whom the occurrence of haematidrosis in a context of intense family stress led to the diagnosis of non- epileptic psychogenic seizures.
