Multiple myeloma revealed by spinal cord compression and herpes zoster in a 36- year-old Cameroonian

Multiple myeloma is a malignant plasma cell disorder occurring mostly in people above 60 years old. The authors describe a case of multiple myeloma in a 36-year-old patient revealed by spinal cord compression and Herpes zoster with a rapidly unfavourable outcome

Anterior Pituitary Endocrine Dysfunctions in Patients with Traumatic Brain Injury in the Neurosurgical Units of the Yaounde Central and General Hospitals: A Cross-Sectional Study

Background: Post-traumatic endocrine dysfunction (PTED) is an important and relatively common complication of TBI (traumatic brain injury). It is usually undiagnosed and untreated making it a major cause of poor outcome in TBI patients as it can lead to death, delayed recovery, cognitive impairment, depression, sexual dysfunctions and infertility. Study Design: Analytic cross-sectional study at the Yaounde Central and General Hospitals from January 2022 to April 2022. The main aim of this study was to evaluate the endocrine dysfunctions and factors associated to their occurrence in patients presenting TBI at the neurosurgical units of the Yaounde Central and General Hospitals. Methods: Patients were enrolled at the neurosurgical units Data was collected with the help of a questionnaire after obtaining their informed consent alongside with blood samples in the morning (between 8AM and 10AM) for screening of anterior hypothalamo-pituitary axis hormones (FSH, LH and TSH) and relative peripheral hormones (cortisol, T4, oestrogene in women and testosterone in men) using fluorescence immunoassay. The study population was made up of all patients diagnosed with TBI during the study period at study sites. Patients taking medications affecting the hypothalamo-pituitary axis were excluded. Variables of interest included socio-demographic variables, clinical variables and paraclinical variables. Data was inserted and analyzed using the software Statistical Package for Social Sciences (SPSS) version 26.0. Association between variables was done using Fisher’s exact test. The association measure used was odd’s ratio (OR) with confidence interval (CI) of 95%. Results: A total of 33 participants were enrolled, out of which 26 responding to our inclusion criteria were retained and 7 excluded because they were on medications affecting the hypothalamo-pituitary axis. The median age of participants was 34 (26,75–41,25) years. There was a predominance of the male population with a sex ratio of 12:1. A total of 17 participants developed PTED (65.38%). The PTED encountered were FSH deficiency (12 patients at 46,1%), LH deficiency (10 patients at 38,4%), morning cortisol deficiency (5 patients at 19,2%), TSH deficiency (7 patients at 26,9%), testosterone deficiency (5 patients at 19,2%) and multiple deficiencies (12 patients at 46,1%). PTED was also found in 6 patients with severe TBI, 6 patients with moderate TBI and 5 patients with mild TBI (35.3%, 35.3% and 29.4%). In ≤7 days from TBI, 11 patients suffered PTED (64.7%) while after 7 days post-TBI, only 6 patients suffered PTED (35.3%). Tiredness was the most frequent symptom observed in 15 patients with PTED (88.2%). No factors associated to the occurrence of PTED were found in this study (p-values were all >0.05). Conclusion: This study suggests that PTED is a common condition amongst sufferers of TBI. PTED occurs in both genders and the most frequent types of anterior pituitary endocrine dysfunctions were hypogonadism, hypothyroidism and lastly corticotropic insufficiency. Most patients with PTED had associated CT-scan lesions. No factors was significantly associated to the occurrence of PTED probably due to small sample size

Surgical treatment and outcome of 195 cases of non acute subdural haematoma at the Youndé Central Hospital: The need for landmarked burr holes

Background Chronic subdural hematoma (CSDH) is frequent neurosurgical pathology but many issues related to the surgical procedure are still discussed.Objective To present our experience in the treatment of Non Acute Subdural Hematoma (NASH). Methodology This retrospective study included patients operated for NASH at the Yaoundé Central Hospital from January 2000 to September 2008. Surgery consisted of one burr hole (92.4%), 2 burr holes (3.6%), trephine or craniotomy (4%). All patients underwent per operative irrigation, a 48 hour-postoperative drainage and supine position. The burr hole was performed at the thickest point of the hematoma which in most cases corresponded to the intersection between the superior temporal line and the coronal suture. Results One hundred and ninety five consecutive patients were included: 155 males and 40 females. The mean age was 55 years. The past medical history revealed head injury (81.5%), alcoholism (12.9%), epilepsy (4.1%) or anticoagulation therapy (1.5%). The collection was unilateral (72.8%), bilateral (26.7%) or interhemispheric (1 case). On CT scan, the lesion was hypodense (79.9%), isodense (17.4%) or mixed (2.7%). The mortality rate was 2.5% while the recurrence rate was 3.7% after a 6 to 9 months follow-up period. The main recurrence factor was the inappropriate location of the burr hole.Conclusion One burr hole drainage is an effective and safe method for the treatment of NASH. The location of the burr hole is an important factor of recurrence. There is a need for Landmarked burr holes

Neurocysticercosis: migration and proliferation of cysticercus in a CSF valve

A case of colonization of a CSF shunt device by racemous cysts during a long lasting course of neurocysticercosis is reported

Leptomeningeal cyst in newborns due to vacuum extraction: report of two cases

Two new cases of leptomeningeal cysts subsequent to vacuum extraction are reported. Both children presented with a huge, nonpulsating, transilluminating subgaleal collection over the anterior fontanel that appeared soon after instrument delivery. Plain X-rays, computed tomography, and magnetic resonance imaging confirmed that the subgaleal collection was cerebrospinal fluid and showed the presence of a diastatic coronal suture in both cases. Treatment consisted of duraplasty with periosteal flaps and application of fibrin glue. In one case, an associated porencephalic cyst was treated with a cystoperitoneal shunt. Surgical treatment of leptomeningeal cyst due to vacuum extraction is simple and should not be postponed, despite the tendency for the extracranial cyst to regress, because of the potential risk of continuous growth of an underlying porencephalic cyst and risk of neurological damage

Epidémiologie clinique des fractures du squelette à l’Hôpital St Jean de Malte de Njombe

Le curage ganglionnaire dans les cancers pelviens apporte des  renseignements histo-pronostiques nécessaire sur la survie globale et la survie sans récidive. Nous nous sommes appesantis sur la place réelle qu’occupe ce curage à Dakar en soulignant ces limites. De Janvier 2003 à Décembre 2012 nous avons étudié rétrospectivement les comptes rendus histopathologiques de tous les cancers pelviens opérés et analysés dans les laboratoires publics d’anatomie et cytologie pathologiques de Dakar. Nous avons colligé 470 cas de cancers pelviens dont 184 avaient bénéficié d’un curage ganglionnaire (39,14%). Le nombre moyen de ganglions retrouvé était de 5 (1/17). Le curageilio-obturateur était le plus pratiqué  dans 42,93% (n=79). Le curage ganglionnaire dans les cancers pelviens était plus réalisé au stade précoce du cancer (n=75). Le taux global  d’envahissement ganglionnaire était de 19,02% (n=35). Une taille ganglionnaire de plus de 1cm était associée à un risque élevé  d’envahissement. Le nombre moyen de ganglion envahi par curage était de 4 (1/8). Un traitement néo-adjuvant fut réalisé dans 15,53% (n=73 cas) et était associé à une diminution du risque d’envahissement  ganglionnaire. Le stade tumoral pathologique avancé était associé à un risque élevé d’envahissement ganglionnaire, une bonne différenciation tumorale était par contre associée à une diminution du risque. Aucun type histologique n’était associé à un risque d’envahissement nul. Le siège du curage n’était pas précisé dans 35,86% (n=66). L’effraction capsulaireet la taille tumorale étaient omises dans plus de la moitié des comptes rendus.Mots clés : Curage ganglionnaire, cancer pelvien, envahissement  ganglionnaire.The pelvic lymph node dissection in cancer provides histo-prognostic  information necessary for overall survival and relapse-free survival. We  have scrutinized the actual place of such operation in Dakar by highlighting the limits. From January 2003 to December 2012, we studied respectivelyhistopathological reporting of all pelvic cancers which have been operated  and analyzed in public laboratories of anatomical pathology and cytologyin Dakar. We collected 470 cases of pelvic cancers where lymphadenectomy had been applied in 184 cases (39.14 %). The average number of nodes found was 5 (1/17). Ilio-obturator lymph node dissection was most practiced in 42.93 % (n = 79). Lymphadenectomy in pelvic cancers wasmore applied at the early stage of cancer (n=75). The overall nodal rate was 19.02% (n=35). Lymph node size exceeding 1 cm was associated with a high risk of spread. The average number of lymph nodes involved by  dissection was 4 (1/8). Neo-adjuvant treatment was performed in 15.53% (n = 73 cases), and was associated with a decreased risk of lymph  nodes. The stage of advanced pathological tumor was associated with a high risk of lymph node invasion, whereas real tumor differentiation was associated with a lower risk. No histological type was associated with zerolymph node involvement. The seat of the dissection was not specified in 35.86 % (n = 66). The capsular break and tumor size were omitted inmore than half of the reports.Key words : lymphadenectomy, pelvic cancer, lymph node involvement

Our experience in the management of infantile hydrocephalus: A study on thirty-five regrouped cases in Yaounde, Cameroon

Background: Hydrocephalus is a frequent central nervous system disorder in children, and despite its importance, it has not been sufficiently studied in developing countries. Patients and Methods: A prospective and descriptive study on 35 cases of infantile hydrocephalus was carried out in the neurosurgery unit of the Yaounde Central Hospital, from March 2008 to January 2010. Results: The mean age of the patients was 6.69΁1.58 months, and the majority of them were in the 0-6 months age group (71.43%). The most frequent causes were congenital malformations, with stenosis of the aqueduct of Sylvius being the most represented (31.43%). As radiological workup, a CT scan was done in more than half of the cases (57.15%), and ventriculo-peritoneal shunting was the main surgical method of management used (94.29%). Infectious complications were observed in 22.86% of our cases. Conclusion: Hydrocephalus is a frequent disorder in this Cameroonian setting affecting mostly the 0-6months age group. For early diagnosis to be made, the head circumference of neonates should be routinely measured in the labour room and followed-up in all medical visits. To avert complications following surgery, rigorous surgical procedures with effective asepsis and appropriate methods and materials for shunting should be used

Les Hematomes Extra-Duraux Post Traumatiques : Prise En Charge Medico-Chirurgicale A Yaounde

Introduction L\'hématome extra dural (HED) est une urgence chirurgicale majeure. Son diagnostic et sa prise en charge dans les pays en voie de développement se heurtent à des difficultés inhérentes à la fois à la modestie des plateaux techniques et au coût trop onéreux des soins pour des malades souvent démunis, sans système d\'entraide national. Objectif Le but de cette étude est d\'établir le profil épidémiologique des patients victimes d\'un HED à Yaoundé, de relever les difficultés dans la prise en charge et d\'évaluer les résultats à court et à moyen terme. Patients et Méthodes Il s\'agit d\'une étude descriptive allant de Janvier 1999 à Décembre 2004. Tous les patients pris en charge (trousse neurochirurgicale d\'urgence) pour un hématome extra dural dans l\'une des formations hospitalières de Yaoundé ont été inclus. Résultats Sur les 38 patients recrutés, le sexe masculin était prépondérant avec un sexe ratio de 3.8/1. L\'âge moyen était de 24,5 ans (extrême allant de 3 à 48 ans). Les accidents de la voie publique constituaient l\'étiologie la plus fréquente (55,3% des cas). Le traitement chirurgical était principalement une craniotomie (81,1% des patients opérés). Le traitement médical avant la chirurgie était variable. Le GOS dans le collectif était évalué à 5 (2 patients décédés), 2 (4 patients avec des séquelles) et 1 (32 patients avec une récupération complète). Conclusion Ce travail démontre l\'intérêt de disposer d\'une trousse neurochirurgicale d\'urgence pour une prise en charge optimale dans notre contexte. Background Extra dural hematoma (EDH) is a major surgical emergency but its management in developing countries is still hindered by several difficulties related to infrastructure and financial accessibility to care in health systems that usually a national insurance policy. This study looked at the epidemiology, difficulties and short term results of using a simple emergency neurosurgical kit in the management of EDH in Yaounde. Patients and Methods This was a descriptive study from January 1999 to December 2004. All consecutive patients managed for extra dural hematoma (emergency neurosurgical kit) in any of the hospitals of Yaounde during this period were included. Results Thirty-eight (38) patients were included, with male predominance (sex ratio 3.8/1). The mean age was 24.5 years (range : 3 to 48). Road traffic accidents was the main etiologic factor (55.3%). Most of the patients underwent craniotomy (81.1%) or craniectomy. Peri-operative medical treatment was variable. The GOS was 5 (2 dead patients), 2 (4 patients with sequellae) et 1 (32 patients with complete recovery). Conclusion This work shows the value of an emergency neurosurgical kit for optimising the management of extra dural hematoma in our context of practice. Keywords: Hématome extra dural, Afrique, Trépanation / Extra dural hematoma, Sub Saharan Africa, Burrhole surgeryAfrican Journal of Neurological Sciences Vol. 24 (2) 2005: pp.33-3