Neurolupus with multiple cerebral vascular infarctions and postpartum psychosis manifestations: A diagnostic and therapeutic challenge

Background: Neurolupus is mediated by inflammation and autoimmunity in the nervous system. Its initial presentation as psychosis is rare, posing diagnostic and therapeutic challenges. Case presentation: A 36-year old woman presented at four weeks postpartum with acute psychosis, depression and cognitive dysfunction. Three months later, cerebrovascular involvement was suspected due to aphasia. Brain MRI showed multifocal infarctions, and autoimmune antibodies fulfilled criteria of Systemic Lupus Erythematosus. Outcome: She was treated successfully with corticosteroids and immunosuppressors, and is on azathioprine as maintenance therapy. Conclusion: Acute psychosis in postpartum period can be due to organic causes, there should be a high index of suspicion of autoimmune disease as neurolupus.   English title: Neurolupus avec infarctus cérébraux multiples et psychose postpartum: Difficultés diagnostiques et thérapeutiques  Introduction: Le neurolupus englobe les manifestations neurologiques centrales et psychiatriques au cours du lupus érythémateux systémique, qui sont dues à une atteinte auto-immune et une inflammation chronique du système nerveux. La présentation initiale du neurolupus comme psychose en période postpartum est rare et pose des difficultés diagnostiques et thérapeutiques pouvant retarder la prise en charge. Présentation du cas: Nous présentons le cas d`une femme de 36 ans sans antécédents précédents de lupus érythémateux dissémine ni de troubles psychiatriques, qui a quatre semaines postpartum à présente une psychose aigue associe à une dépression et des troubles cognitifs. Au bout de trois mois, elle a présenté de façon brutale une aphasie faisant évoquer une atteinte cérébrovasculaire. Un bilan a la recherche d`une cause organique a objectivé a l`IRM cérébrale de multiples lésions d`infarctus dissémines en plusieurs territoires vasculaires. Le dosage des anticorps antinucléaires, d’anticorps anti-ADN natif, anticorps anti-Sm était anormales. Devant ce tableau clinique, immunologique et l`imagerie, nous avons évoqué le diagnostic de neurolupus. Evolution: La patiente a bénéficié d’un traitement immunosuppresseur à base de corticoïdes, ensuite relayé avec du cyclophosphamide, puis Azathioprine. Elle a également été traitée par administration de la risperidone et de l’aspirine à 100mg/jour pour prévenir un éventuel accident vasculaire cérébral secondaire. L`évolution a été favorable, marquée par la disparition des symptômes psychotiques et neurologiques au bout de quelques mois, si bien qu’elle a repris ses activités normales. Conclusion: Les troubles psychotiques aiguées associées à des troubles neurologiques en postpartum peuvent être due aux causes organiques. Devant une forte suspicion d`auto-immunité, le neurolupus doit être évoqué

Hypertension in Cameroon associated with high likelihood of obstructive sleep apnea: a pilot study

Abstract Background Although disordered sleep patterns predispose to hypertension (HTN), little is known on the effect of the latter on sleep patterns in sub-Saharan Africa. This study therefore sought to generate preliminary data on the likelihood (risk) of Obstructive sleep apnea (OSA) in hypertensive patients, with the aid of sleep questionnaires. Methods This case–control study, age-and-sex-matched HTN patients with normotensive participants, and compared sleep patterns in either group determined with the aid of the Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS). Results Overall, 50 HTN and 54 age- and sex-matched normotensive participants were enrolled. The prevalence of snoring was higher in participants with hypertension compared to normotensives (58.0% versus 44.0% respectively), though not significantly, (p = 0.167). However, the hypertensive cases (aged on average 54.78 ± 8.79 years and with mean duration since diagnosis of 4.46 ± 4.36 years) had a significantly higher likelihood of Obstructive Sleep Apnea (OSA) than the controls (aOR = 5.03; 95% CI, 1.90–13.33, p = 0.001) and but no significant resulting daytime sleepiness (p = 0.421). There was no clear trend observed between both the risk of OSA and daytime sleepiness and HTN severity. Although not significant, participants with controlled hypertension had lower rates of risk of OSA compared to those with uncontrolled HTN (50.0% versus 63.2%, p = 0.718). Conclusions Preliminary findings of this study (the first of its kind in Cameroon) suggests that hypertension is positively associated with likelihood of OSA in Cameroon. Further studies are required to investigate this further and the role of sleep questionnaires in our setting, cheap and easy to use tools which can be used to identify early, patients with hypertension in need for further sleep investigations. This will contribute to improving their quality of life and adherence to anti-hypertension treatment

Epilepsy-associated neurocognitive disorders (EAND) in an onchocerciasis-endemic rural community in Cameroon: A population-based case–control study

Epilepsy affects at least 50 million individuals worldwide, especially in sub-Saharan Africa (sSA). Cognitive impairment is common in people with epilepsy (PWE) yet, little is known on the burden of cognitive impairment in people with epilepsy in sSA. This study was thus designed to assess cognitive impairment in PWE or epilepsy- associated neurocognitive disorders (EAND) in a rural population in Cameroon.Methods: This was a case–control study including PWE and age/sex- matched healthy controls from July to September 2017 in Bilomo, a village in the Mbam and Kim Division. The Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), Dubois' Five Word testing, Frontal Assessment Battery (FAB), Isaac's Set Test and the Clock drawing test were administered to the study participants to evaluate global and specific cognitive functions.Results: Eighty participants were included (40 cases and 40 controls) with a mean age of 25.78 years. Using the MoCA, 87.5% of cases had cognitive impairment, against 37.5% of controls (p < 0.001; OR 11.67; CI 3.40–45.09). Using the IHDS, the prevalence of global cognitive impairment was 84.6% among the cases against 40% for the controls (p = < 0.001; OR 7.07; CI 2.29–29.19). Specifically, executive function deficits (92.5% of cases vs 40.0% of controls p = < 0.001 OR = 18.50 CI; 4.48–105.08) and decreased verbal fluency (100% of cases against 45% of controls p < 0.001) were the most affected cognitive domains. Longer duration of epilepsy and higher seizure frequency were associated with global cognitive impairment. Low level of education was associated with both decreased verbal fluency and executive dysfunction while a longer stay in Bilomo correlated with poor results on the Isaac's Set Test.Conclusion: The prevalence of cognitive impairment appears to be much higher in PWE in the Mbam valley, particularly decreased executive function and verbal fluency, than in people without epilepsy. Longer disease duration, higher seizure frequency, low level of education and length of stay in Bilomo are associated with poorer cognitive performance. More studies are needed to refine evaluation tools to better characterize and manage EAND in sSA

Epilepsy in the Sanaga‐Mbam valley, an onchocerciasis‐endemic region in Cameroon: electroclinical and neuropsychological findings

International audienceThis is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made

Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon: Impact of more than 13 years of ivermectin

Background: A high epilepsy prevalence has been reported in several onchocerciasis-endemic villages along the Mbam and Sanaga river valleys in Cameroon, including Bilomo and Kelleng. We sought to determine the prevalence of epilepsy in these two villages following more than 13 years of community-directed treatment with ivermectin (CDTI). Methods: Door-to-door surveys were performed on the entire resident population in the villages in August 2017 and January 2018. Epilepsy was diagnosed using a 2-step approach: administration of a standardized 5-item questionnaire followed by confirmation by a neurologist. Previously published diagnostic criteria for onchocerciasis-associated epilepsy (OAE) were used. Ov16 serology was done for children aged 7-10 years to assess onchocerciasis transmission. Findings were compared with previous data from these two villages. Results: A total of 1525 individuals (1321 in Bilomo and 204 in Kelleng) in 233 households were surveyed in both villages. The crude prevalence of epilepsy was 4.6% in Bilomo (2017) and 7.8% in Kelleng (2018), including 12 (15.6% of cases) persons with epilepsy (PWE) with nodding seizures. The age and sex-standardized prevalence in Kelleng decreased from 13.5% in 2004 to 9.3% in 2018 (P < 0.001). The median age of PWE shifted from 17 (IQR: 12-22) years to 24 (IQR: 20-30) years in Bilomo (P < 0.001); and slightly from 24 (IQR: 14-34) years to 28 (IQR: 21.25-36.75) years in Kelleng (P = 0.112). Furthermore, 47.6% of all tested children between 7 and 10 years had Ov16 antibodies. Conclusions: There is a decrease in epilepsy prevalence after 13 years and more of CDTI in both villages. The age-shift observed in PWE suggests that ivermectin may prevent OAE in younger residents. Ov16 seropositivity in children indicates ongoing onchocerciasis transmission possibly due to suboptimal control measures. Our findings support the existence of OAE in Cameroon and highlight the need to strengthen onchocerciasis elimination programs.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Fear and depression during the COVID-19 outbreak in Cameroon : a nation-wide observational study

Abstract Background The COVID-19 pandemic has been associated with significant psychological and social distress worldwide. We investigated fear and depression among adults in Cameroon during different phases of the COVID-19 outbreak. Methods An online survey was conducted in Cameroon from June–December 2020 using a structured questionnaire. Socio-demographic data and information regarding COVID-19 history were obtained. Fear and depressive symptoms were assessed using the Fear of COVID-19 score (FCV-19S) and the Patient Health Questionnaire (PHQ-9), respectively. Responses were clustered in weeks to better appreciate their evolution over time. Results Overall, 7381 responses from all ten regions of Cameroon were analysed (median age: 30 years, 73.3% male). The prevalence of depression (PHQ-9 score ≥ 10) was 8.4%, and that of high fear of COVID-19 (FCV-19S scores ≥19) was 57.4%. These rates were similar across genders, age-groups, and region of residence. While mean weekly PHQ-9 scores remained fairly stable throughout the study period (range: 2.53–3.21; p = 0.101), mean FCV-19S scores were highest during the early weeks but decreased significantly thereafter (from 20.31 to 18.34; p <  0.001). Multivariate analyses revealed that having a postgraduate degree, a history of quarantine, flu-like symptoms during the past 14 days, and higher FCV-19S scores were associated with more severe depressive symptoms, while obtaining COVID-19 information from various sources reduced the odds for depression. Conclusion Depression amidst the COVID-19 crisis is less prevalent in Cameroon than in other countries. Prompt and widespread dissemination of adequate COVID-19 information may reduce the risks for depression by dispelling fear and anxiety among Cameroonians