Communication interventriculaire post infarctus du myocarde: à propos d’un cas et revue de la litterature

La rupture septale secondaire à l'infarctus du myocarde est une complication aiguë redoutable dont la mortalité est non négligeable à la phase précoce. Nous rapportons le cas d'une rupture septale apicale chez un patient de 70 ans admis aux urgences pour prise en charge d'un post infarctus de myocarde antéro-septal. C'est une urgence extrême dont la prise en charge doit être multidisciplinaire. Nous mettons le point sur les facteurs de risque et sur le traitement à proposer pour ce type de complication.Mots clés: Infarctus du myocarde, communication interventriculaire, MarocEnglish Title: Interventricular defect after myocardial infarction: about a case and literature reviewEnglish AbstractVentricular septal rupture (VSR) after myocardial infarction is a fearsome acute complication whose mortality is not negligible in the early phase. We report the case of a 70-year old patient with apical septal rupture admitted to the Emergency Department with ventricular septal rupture after anteroseptal myocardial infarction. This disease is of the utmost urgency, so its management should be multidisciplinary. This study aims to focus on the risk factors and the treatment of this complication.Keywords: Myocardial infarction, inter-ventricular communication, Morocc

Complication rare et grave de la rachianesthésie: la méningite bactérienne (à propos d’un cas et revue de la littérature)

La rachianesthésie (RA) est la première anesthésie locorégionale. Elle comporte des effets secondaires et des risques qu'il faut pouvoir éviter, prévenir ou traiter précocement. C'est le cas d'une patiente opérée sous rachianesthésie qui a présenté quelques jours après l'interventionde céphalées intenses associées à des nausées et des vomissements évoluant dans un contexte de fièvre. La ponction lombaire mettait en évidence un liquide trouble avec la présence de cocci gram + à l'examen direct, ce qui a permis de poser le diagnostic d'une méningite bactérienne et dont l'évolution a été favorable après antibiothérapie.Mots clés: Méningite bactérienne, rachianesthésie, nosocomiale, complication grave, asepsieEnglish Title: Rare and severe complication of spinal anesthesia: bacterial meningitis (about a case and literature review)English AbstractSpinal anesthesia (SA) is the first locoregional anesthesia. It can cause side effects and carry risks that need to be avoided, prevented or treated early. We here report the case of a female patient operated under spinal anesthesia who had intense headache associated with nausea and vomiting evolving in the context of fever within a few days after surgeryLumbar puncture showed cloudy liquid revealing Gram + cocci on direct examination. This allowed the diagnosis of bacterial meningitis. Patient’s evolution was favorable after antibiotic therapy.Keywords: Bacterial meningitis, spinal anesthesia, nosocomial, serious complication, asepsi

Thrombolysis for acute ischemic stroke by tenecteplase in the emergency department of a Moroccan hospital

Introduction: Thrombolysis has radically changed the prognosis of acute ischemic stroke. Tenecteplase is a modified form of rt-PA with greater specificity for fibrin and a longer half-life. We report the experience of a Moroccan tertiary hospital in thrombolysis using Tenecteplase. Methods: We conducted an open prospective study of all patients who were treated with Tenecteplase for an acute ischemic stroke admitted to our emergency department. Tenecteplase was administered intravenously at a dose of 0.4 mg/kg single bolus. The primary outcome measure was the proportion of patients achieving significant early neurological recovery defined as an improvement of 4 or more points on the NIHSS score at 24h. Results: 13 patients had been treated by intravenous thrombolysis. 31% were women. Mean age was 63 years old. The mean NIHSS score at admission was 14.3 and 24h after was at 9.1. The right middle cerebral artery was involved in 69% of cases. The carotid atherosclerosis was predominant 63.3% and the cardio embolic etiology 27%. The mean time to the first medical contact after the onset of symptoms was 3h 30 min. One patient presented a capsulo-lenticular hematoma of 5 mm3 in the same side of the ischemic stroke. Conclusion: Tenecteplase is a more interesting thrombolytic than alteplase, it seems to be more suitable for thrombolysis in our center.Keywords: Acute ischemic stroke, thrombolysis, tenecteplas

Management of Ischemic Stroke during cardiac catheterization: A case report and review of literature

Stroke following coronary interventions is a devastating and most dreaded complication with signiβicant morbidity and mortality. Various factors have been ascribed for this complication including the technical errors [1]. A small percentage of strokes are iatrogenic, including those associated with invasive cardiac procedures. According to the literature, it is a rare complication of left heart catheterization [2]. Percutaneous coronary intervention is increasingly used to treat patients with diffuse atherosclerosis, acute coronary syndromes and even high-risk patients such as low ejection fraction [1]. The authors describe a patient who underwent percutaneous coronary intervention in the context of inferior infarction, which was complicated by ischemic stroke during cardic catheterization