In-Hospital Evolution of Non Operated Aneurysmal Subarachnoid Hemorrhage at the Neurology Unit of Befelatanana University Teaching Hospital, Antananarivo

Subarachnoid hemorrhage is defined as a sudden irruption of blood in subarachnoid spaces. This study aims to determine the profile and in-hospital evolution of patients with post aneurysmal subarachnoid hemorrhage, who did not have surgical treatment in the Neurology Unit of Befelatanana University Hospital, Antananarivo, Madagascar. This study was a descriptive retrospective study within a period of 4 years, from January 1st, 2014 to December 31th, 2017. The study was carried out in hospitalized patients for subarachnoid hemorrhage with aneurysmal origin. We included 52 patients, with an average age of 48 years and a female predominance. They are housewives in majority of cases. 52% of the cases live in urban areas while 77% of cases have high blood pressure. The main clinical manifestation was a sudden headache, and intracranial aneurysm was located at the anterior communicating artery in 52% of cases. All patients benefited from drug treatments in majority of cases. Due to the lack of financial means, 60% had neurological complications. However, in-hospital mortality rate was at 13%. This study helps us to suggest to our patients medical treatment of their subarachnoid hemorrhage during hospitalization because of difficult access to surgery. It also aims to propose surgery outside the acute phase of the disease

Mortalite A La Phase Aiguë De L’avc Hemorragique Sous Notre Protocole De Baisse De La Tension Arterielle A l’Hopital Universitaire (HU) Befelatanana Antananarivo

Introduction: Hemorrhagic stroke can be seen in 90% of cases with high blood pressure. It is a predictor of intra-hospital mortality. Our goal is to compare the mortality rate based on admission under our therapeutic strategy for HTA in the acute phase of stroke. Method: A retrospective descriptive, cross-sectional study of consecutive patients was conducted over a 12-month period during the year 2017. Results: We had 20% (3/15) mortality rate in acute phase in those with systolic blood pressure (SBP) in admission at ≥ 180 mmHg (group II) and no death (0/17) was recorded in the those with SBP in admission at 140-179mmHg (group I). A SBP at the 7th day (D7) less than 140 mmHg was not rich in those two groups: 35.29 % in group I (n=6) and 46.66 % in group II (n=7) respectively. The sex ratio was 1. High blood pressure remains the main cardio-vascular risk factor reported in our study (81.21%). All our patients had Glasgow scale value between 13-15 and only the NIHSS value > 10 was associated with high blood pressure in acute phase (p=0.0131). Brain CT Scan was realised in majority of cases at the second day (D2) of stroke (n=16). This, however, is with localisation preference in the basal ganglia, with intra-cerebral hemmorhage (ICH) scale at 1 in 65.62% (n=21) of cases. Conclusion: Intra-hospital mortality in acute phase of hemorrhagic stroke remains high. Instauration of stroke field in Madagascar is necessary and this gives the Befelatanana University Hospital a Neuro- Vascular Intensive Care Unit too

WEIGHT FOR MONITORING AND EVALUATION OF CHILD UNDER 5 YEARS OLD EPILEPSY

Introduction : Monitoring the weight curve is part of the assessment of good child development. We decided to use this as a model of evaluation and monitoring of epilepsy treatment in children. Material and methods: We performed a cohort study of newly diagnosed epileptic children treated at the Laboratory of Neuroscience and Mental Health Antsakaviro, Madagascar from January 2015 to July 2016 during  12 months  follow-up. Weight gain was analyzed according to treatment effectiveness. Results: We included 106 children with 64 boys and 42 girls. After 6 months of treatment, the sensitivity of weight gain with the effectiveness of treatment was 88.65%, the specificity at 77.78%, the positive predictive value at 97.77% and the negative predictive value at 38.38%. We noted a slowdown in growth in 88.89% of cases in children with ineffective treatment against 18.56% for those with effective treatment. After 12 months, the sensitivity was 89.28%, the specificity at 54.54%, the positive predictive value at 88.23% and an increase in the negative predictive value 57.14%. Conclusion  : Our results suggest that weight can be a complement of assessment and monitoring of epilepsy in children. More extended studies are needed to confirm this method

Increasing Frequency of Parkinsonian Syndrome as a Reason for Admission to the Neurology Department of Befelatanana University Teaching Hospital, Madagascar

The number of parkinsonian syndrome patients in Africa is increasing. This study evaluated the increasing number of parkinsonian syndrome (PS) patients admitted to a hospital in Madagascar. A comparison was carried out between parkinsonism syndrome plus (PS+) and idiopathic Parkinson's Disease (PD) cases. Retrospectively, case records of patients with parkinsonism was reviewed between 2009 and 2018 in the Neurology Department of Befelatanana University Teaching Hospital, Antananarivo. Out of the 7343 patients seen in the unit over this period, 157 patients with PS were retained. It was found that PS frequency has increased significantly as a reason for admission since 2013. PS as a reason for admission rose from 0.64 % in 2009 to 29.30 % in 2018. The median age of diagnosis of PS was 60.75 years ± 10.66. The mean age of disease onset was 57.95 years ± 10.99, with a mean diagnosis delay of 3.19 years and a sex ratio of 1.275. Among those with PS, 112 (71.33%) had PD and and 45 (28.66%) had other parkinsonian syndromes. It was also found that patients with PD had a longer diagnosis delay (p = 0.039), a higher Mini-Mental Status Examination (MMSE) scores (p = 0.035), and they were more dopa-sensitive (p = 0.007) than those with other parkinsonian syndromes. In the facility in Madagascar, the number of referrals for PS and PD has increased over time and they have the same features as parkinsonian syndromes in other African countries