Validation of an algorithm of time-dependent electro-clinical risk stratification for electrographic seizures (TERSE) in critically ill patients.

The clinical implementation of continuous electroencephalography (CEEG) monitoring in critically ill patients is hampered by the substantial burden of work that it entails for clinical neurophysiologists. Solutions that might reduce this burden, including by shortening the duration of EEG to be recorded, would help its widespread adoption. Our aim was to validate a recently described algorithm of time-dependent electro-clinical risk stratification for electrographic seizure (ESz) (TERSE) based on simple clinical and EEG features.info:eu-repo/semantics/publishe

Insights in the pathophysiology of haemorrhagic strokes in a sub-Sahara African country, an epidemiological and MRI study

Objective: Intra-cerebral Haemorrhage (ICH) seems more prevalent in sub-Saharan Africa (SSA) than in High-Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns. Methods: Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme-ULB Hospital and at Conakry Ignace Deen-UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30 days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen-UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels’ initial cohort. Paired Student’s t-test and Mann–Whitney u-test were used for group comparisons. Results: Age of ICH onset was higher in Belgium (68 ± 17 years vs. 56 ± 14 years, P < 0.01) while ICH volume and 30-day mortality rate were higher in Guinea (20 ml vs. 11 ml, P < 0.01 and mortality 33% vs. 10 %, P < 0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P = 0.09) and poor outcomes in 10.3% vs. 29.6% (P < 0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics. Conclusions: Intra-cerebral Haemorrhage affected patients 15 years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

GENERAL PARALYSIS IN A TROPICAL COUNTRY. STUDY OF 43 OBSERVATIONS

PARALYSIE GÉNÉRALE EN MILIEU TROPICAL. ÉTUDE DE 43 OBSERVATIONS RESUME Description :Les auteurs rapportent une étude de 43 cas de paralysie générale, révélés par un syndrome démentiel et des formes atypiques notamment les troubles confusionnels répétitifs et des crises épileptiformes. Objectif : L'objectif de cette étude est de réévaluer cette pathologie du point de vue clinique et paraclinique en milieu tropical. Méthode : Il s'agit d'une étude prospective. Le diagnostic a reposé sur la positivité des réactions sérologiques ( VDRL-TPHA) dans le sang et le liquide céphalo-rachidien, la présence d'une hypercellularité à prédominance lymphocytaire et d'une hyperprotéinorachie. Resultats : Les troubles cognitifs et moteurs, les états confusionnels répétitifs et les crises épileptiques constituent les formes cliniques dominantes de début. Chez tous les patients, le scanner a mis en évidence une discrète dilatation ventriculaire diffuse et un élargissement des sillons de la convexité. Le tracé électroencéphalographique était anormal dans près de 67% des cas. SUMMARY Description : The authors report a study of 43 cases of general paralysis revealed by some mental disorders and atypical forms notably repeater confessional disorders and some seizure-like attacks. Objective : The goal of this study is to revalue this pathology from the clinical and paraclinic point of view in tropical medium. Method : In this prospective study, the diagnosis was based on the serologic tests (VDRL-TPHA) in the blood and the cerebrospinal fluid (CSF); CSF cell count with lymphocyte predominance ; protein level in the fluid. Result : The diagnosis was based on the serologic tests (VDRL-TPHA) in the blood and the cerebrospinal fluid(CSF); high CSF cell count with lymphocyte predominance; high protein level in the fluid. The cogniture and motor troubles, the repeated confusion status and the epileptic seizures constitute the dominant clinical forms of the onset. In all the patients, the CT-scan revealed discrete diffuse ventricular dilation and widening of the grooves of the convexity. The electroencephalographic traces were abnormal in 67% of the cases. Key Words: Afrique, Guinée, paralysie générale, syphilis nerveuse, Africa, Guinea, general paralysis, neurosyphilis African Journal of Neurological Sciences Vol.23(2) 200

Stroke burden in Guinea: Results from the Conakry Ignace Deen Hospital stroke registry

Sub-Saharan Africa has extremely high stroke prevalence and case fatality. Most Sub-Saharan African regions are uncharted in terms of stroke characteristics, epidemiology, and burden. We report here the results from the first stroke registry in Guinea.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Minimal setting stroke unit in a sub-Saharan African public hospital

Introduction: Sub-Saharan Africa (SSA) has the highest stroke prevalence along with a case fatality that amounts to 40%. We aimed to assess the effect of a minimal setting stroke unit in SSA Public hospital on stroke mortality and main medical complications. Materials and Methods: The study was set in Conakry, Guinea, Ignace Deen public referral hospital. Clinical characteristics, hospital mortality and main medical stroke complications rates (pneumonia, urinary tract infections, sores and venous thromboembolism) of admitted stroke patients after the installation of a minimal stroke unit equipped with heart rate, blood pressure and blood oxygen saturation monitoring and portable oxygen concentrator (POST) were compared to a similar number of stroke patients admitted before the stroke unit creation (PRE). Results: PRE (n = 318) and POST (n = 361) stroke, patients were comparable in term of age (61 ± 14 vs. 60 ± 14.8 years, p = 0.24), sex (56 vs. 50% males, p = 0.09), High blood pressure rate (76.7 vs. 79%, p = 0.44), stroke subtype (ischemic in 72 vs. 78% of cases, p = 0.05) and NIHSS (11 ± 4 vs. 11 ± 4, p = 0.85). Diabetes was more frequent in the PRE group (19 vs. 9%, p < 0.001). Mortality was significantly lower in the POST group (7.2 vs. 22.3%, p < 0.0001) as well as medical complications (4.1 vs. 27.7%, p < 0.001) and lower pneumonia rate (3.3 vs. 14.5%, p < 0.001). Conclusions: Minimally equipped stroke units significantly reduce stroke mortality and main medical complications in SSA.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Predictors of stroke favorable functional outcome in Guinea, results from the Conakry stroke registry.

Low- to middle-income countries (LMICs) now bear most of the stroke burden. In LMICs, stroke epidemiology and health care systems are different from HICs. Therefore, a high-income country (HIC)-based predictive model may not correspond to the LMIC stroke context. Identify the impact of modifiable variables in acute stroke management in Conakry, Guinea as potential predictors of favorable stroke outcome. Data were extracted from the Conakry stroke registry that includes 1018 patients. A logistic regression model was built to predict favorable stroke outcomes, defined as mRS 0-2. Age, admission NIHSS score, mean arterial blood pressure and capillary glycemia were chosen as covariates. Delay to brain CT imaging under 24 h from symptom onset, fever, presence of sores and abnormal lung auscultation were included as factors. NIHSS score on admission, age and ischemic stroke were included in the null model as nuisance parameters to determine the contribution of modifiable variables to predict stroke favorable outcome. Lower admission NIHSS, brain CT imaging within 24 h of symptoms onset and lower mean arterial blood pressure emerged as a significant positive predictors of favorable stroke outcome with respective odd ratios (OR) of 1.35 [1.28-1.43], 2.1 [1.16-3.8] and 1.01 [1.01-1.04]. The presence of fever or sores impacted negatively stroke favorable outcomes with OR of 0.3 [0.1-0.85] and 0.25 [0.14-0.45]. The area under receiver operating characteristic curves (AUC) of the model was 0.86. This model explained 44.5% of the variability of the favorable stroke outcome with 10.2% of the variability explained by the modifiable variables when admission NIHSS, and ischemic stroke were included in the null model as nuisance parameter. In the Conakry stroke registry, using a logistic regression to predict stroke favorable outcome, five variables that led to an AUC of 0.86: admission NIHSS, early brain CT imaging, fever, sores and mean blood pressure. This paves the way for future public health interventions to test whether modulating amendable variables leads to increased favorable stroke outcomes in LMICs.info:eu-repo/semantics/publishe