Peripheral facial paralysis (PFP ) is a neurological manifestation commonly encountered in neurosurgical consultation. The objective of this study was to correlate the disease and HIV AIDS. This is a retrospective study from October 2008 to September 2012 which involved all patients with PFP in consultation with neurosurgery. Patients had a complete neurological examination and blood diagnostic tests , biological and radiological . An otorhinolaryngologic consultation was carried out by all patients. Our series included 36 patients including 11 women . The ages ranged between 20 and 42 years . Facial paralysis was right in 22 patients ( 61.11 %) , paresis interested hemifacial . The review otorhinolaryngologic was normal in all patients as all brain CT-scan. In the series 28 patients ( 77.77 %) were seropositive The Elisa and Western blot confirmed the presence of HIV-1 in all patients and HIV 2 in 8 . The treatment consisted in the administration of prednisolone and antiretrovirals. The outcome was favorable in all patients with the gradual disappearance of facial paralysis in 20 patients in 8 weeks and 16 more in 6 months. The presence of HIV 1 and 2 in 77.77 % of patients due to facial paralysis is an indicator of HIV AIDS in the department of neurosurgery.
Le kyste dermoide est une formation tumorale benigne. Il s’agit d’une pathologie d’origine presque toujours congenitale tout comme l’agenesie du corps calleux. L’oxycephalie est un type particulier de craniostenose d’origine differente des autres. Son etiologie reste pour une large part inconnue de nos jours. La presence simultanee de ces deux entites pathologique chez le meme sujet est exceptionnelle. Dans la litterature aucun cas decrit associant kyste dermoide intracrânien, agenesie du corps calleux et oxycephalie n’a ete retrouve. Les auteurs rapportent un tres rare cas associant un kyste dermoide a une microcephalie chez un patient de trois ans. Une fois l’expression clinique manifestee, la prise en charge chirurgicale du kyste et/ou de la craniostenose devient un imperatif. Le resultat est fonction de la precocite du traitement et de l’empreinte cerebrale initiale laissee par les lesions. Mots cles: cerveau, craniostenose, kyste dermoide, syndrome polymalformaltif English Abstract Dermoid cyst is a benign tumor. This is an original pathology which is almost always congenital presenting as agenesis of the corpus callosum. Oxycephaly is a special kind of craniosynostosis of different origin than the others. Its etiology remains largely unknown to this day. The simultaneous presence of these two pathological entities in the same subject is exceptional. No case found in the literature describes an association involving intracranial dermoid cyst, corpus callosum agenesis and Oxycephaly. We report a rare case involving a dermoid cyst with microcephaly in a three-year old patient. Once clinically expressed, surgical treatment of the cyst and / or craniosynostosis becomes imperative. The outcome depends on early treatment and the initial cerebral mark left by the lesions Keywords: brain, craniosynostosis, dermoidcyst, polymalformative syndrome
Introduction: Extradural hematoma is a common pathology in our department. The natural history of small-volume hematoma is usually towards resorption. In rare cases, the hematoma calcifies and compresses the brain. We report an extradural hematoma in a 15-year-old boy who had a road traffic accident on February 2011. The brain CT-scan performed the following day revealed a small right frontal extradural hematoma. During hospitalization, he had a fever of 40 degrees with convulsions and the blood culture isolated the coagulase-negative staphylococci and Group D streptococci. When his conscience was restored, hemiparesis and dysarthria were observed. The control brain CT-scan performed 2 weeks after the trauma showed early resorption of the hematoma. Two months after the trauma, the brain CT-scan showed calcification of the hematoma. He underwent surgery in April 2011 to remove the calcification. The sequels were hemiparesis and posttraumatic epilepsy. Conclusion: The evolution of a small non-operated extradural hematoma can be done towards calcification thus requiring surgery.
Introduction: Spontaneous intracerebral haemorrhage (ICH) is a rupture of blood vessels in the brain parenchyma, in the absence of any underlying structural vascular lesion. It’s destructive and associated with a high mortality rate. There is a specific threshold of hematoma evacuation to impact mortality or functional outcome in ICH even the curative effect of minimally invasive hematoma removal for cerebral haemorrhage has not been fully recognized worldwide. We aim to evaluate surgical performance on hematoma volume and functional outcomes of patients. Methods: This study is a retrospective and observational clinical study. A total of 30 ICH patients were treated in the Department of neurosurgery at the Hospital of Mali from December 2019 to November 2020. Minimal invasive puncture hematoma removal was performed in all the patients. The modified Rankin scale (mRS) was used to assess functional outcomes at 6 months and one year of surgery. Was considered poor functional outcome mRS >3. The percentages (%) of the count data were assessed by Fisher’s exact test by SPSS 23.0 software was used. Results: A total of 23 ICH patients met the inclusion criteria, the mean was 47,78 years. Among the risk factors, the HTA is present in 91,3% of patients. The evacuation was satisfactory in 91.30% of cases. Conclusion: This first study of minimally invasive stereotaxic for ICH evacuation must be followed up and encouraged. Even if the results are satisfactory, a double-blind study is required in the largest sample.
Objective: The purpose of this study was to determine the incidence , clinical features , localization, and therapeutic aspects of the evolution of the brain abscess. Patients and Methods: This was a retrospective study included patients admitted for brain abscess Gabriel Toure Hospital in Bamako between January 2007 and September 2010. Results: We collected 17 patients. Fever was the predominant symptom in 14 patients and headachein 13 patients. The main clinical signs were hemiparesis ( 11 patients ) and vomiting (8 patients). Theorigin of infection was especially posttraumatic in 5 patients , locoregional by contiguity in 3 to 5whose starting point sinus. All patients received triple antibiotic. The surgical management bytrepanoponction was indicated in 16 patients. The clinical outcome was favorable in 14 patients. Threepatients died.Conclusion: The brain abscess is a common disease in Mali. Despite improved diagnostics andtreatment of patients, mortality remains high when the interest of prevention through early diagnosisand treatment of infectious ORL.
RESUME But. Les processus expansifs intracrâniens sont des pathologies frequemment associees au VIH et dont les causes sont dominees par la toxoplasmose. Le but de cette etude etait de decrire les aspects cliniques et evolutifs des masses cerebrales associees au VIH dans notre service. Methodologie. Il s’agit d’une etude transversale descriptive prospective menee dans le service de neurochirurgie de l’hopital Gabriel Toure et couvrant une periode de deux ans. L’ensemble des dossiers des patients ayant ete hospitalise ont ete depouille, soit au total 14. Les donnees en rapport avec les caracteristiques socioprofessionnelles, cliniques et therapeutiques ont ete etudiees. Resultat. Quatorze patients ont ete etudies. L’âge moyen etait de 29,5 ans avec des extremes allant de 15 a 64 ans. Le sex-ratio a ete de 1,8 en faveur des hommes. La principale voie de contamination etait heterosexuelle (85,7%). A l’admission, 85,8% des patients etaient aux stades III et IV de OMS. Le syndrome d’hypertension intracrânienne etait associe a la fievre chez 28,5% et un deficit moteur focalise chez 21,4%. La toxoplasmose a ete la premiere cause avec 71,4%, la biopsie a ete realisee chez 21,4%. La mortalite a ete de 35,8%. Conclusion. La toxoplasmose est la premiere cause de processus expansif intracrânien associe au VIH dans notre service. Devant toute suspicion de masse intracrânienne associee au VIH, le traitement d’epreuve anti toxoplasmose est fortement recommande. ABSTRACT Aim. To report the clinical presentation and the evolution of expansive intracranial processes in HIV infected patients in our practice. Patients and methods. This transversal descriptive study was conducted in the department of neurosurgery of Gabriel Toure teaching Hospital of Bamako. It covered a period o two years. All HIV positive patients with expansive intracranial processes were included. Our data of interest were sociodemographic, clinical presentation and the evolution with treatment. Results. Fourteen patients were studied. Their mean age was 29.5 years (range: 15 – 64 years). The sex ratio was 1.8. The main route of contamination was heterosexual (85.7%). On admission, 85.8% of patients had WHO stages III or IV. Intracranial hypertension syndrome was associated to fever in 28.5% of patients and focal neurological deficit was present in 21.4% of cases. Toxoplasmosis was the etiology in 71.4% of cases. Biopsy was done in 21.4% of patients. The mortality rate was 35.8%. Conclusion. Toxoplasmosis is the first cause of expansive intracranial processes in HIV infected patients in our practice. A probabilistic treatment is indicated in this context in our setting.
Background: Healthcare-associated infections (HAIs) are increasing in health facilities in Mali, due to health disparities and growing costs. Twenty to fifty percent of HAIs in the surgery department can be prevented with appropriate measures. Objectives: This study aimed to determine the burden of HAI and its risk factors. Materials and Methods: This was a prospective cohort study from January to June 2021 at the CHU Gabriel TOURE, Bamako, Mali. The sample size was determined based on the CDC Atlanta criteria, used to confirm HAI in surgical settings. Demographic, clinical, and biological parameters were determined. For the confirmed case of infection, the incriminated bacteria were isolated and tests were performed for the choice of drugs. Results: Of the total 1001 patients included in this study, 195 patients (19.48%) have HAIs. The types of infections were as follows: 70 cases of surgical site infections, 54 infections on burns victims, 40 urinary tract infections, and 31 cases of bacteraemia. Germs such as Escherichia Coli, Klebsiella pneumoniae, and Acinetobacter were often isolated. We found increasing hospital stays as well as some postoperative mortality related to infections. At the end of this study, corrective efforts were implemented to prevent HAI. Among them are improvements in sterilisation techniques as far as surgical materials were concerned. In addition to a surgical checklist, locally used drapes were replaced with single-use surgical supplies. Advanced training of the surgical team on things such as bladder catheterisation was also conducted in the department. It is important to put in place a committee, to prevent nosocomial infection in our hospital. The selected committee will be responsible for planning and implementing diverse strategies to prevent infections. Conclusions: The prevention of HAIs will reduce health costs and improve the quality of surgical care.
Le traumatisme crânio-encephalique(TCE) constituait une cause non negligeable d’epilepsie secondaire. Aucune etude n’avait etait menee sur l’epilepsie posttraumatique (EPT) au Mali. Les objectifs de ce travail sont: determiner la frequence cette affection, degager les principales lesions cerebrales responsables. Patients et methodes: il s’agissait d’une etude retrospective de janvier 2009 a decembre 2010. Resultat: l’etude a porte sur 31 cas d’EPT sur un total de 757 traumatismes crânio-encephaliques soit 4 ,10 % des cas. Le sexe masculin predominait avec 23 hommes (74,19%) contre 8 femmes (25,81%). Le maximum de cas etait enregistre dans la tranche de 21-25 ans, un âge moyen de 26 ans avec les extremes 4 et 60 ans. Les etiologies etaient dominees par les accidents de la voie publique avec 18 cas (58,06%) suivis par les coups et blessures volontaires avec 9 cas (29,03%) dont 6 par arme blanches et 3 par a feu. Les chutes et les coups de sabot representaient respectivement 3 cas (9,48%) et 1cas (3,23%) Le Glasgow etait inferieur ou egal a 8(traumatisme crânien grave) chez 54,84%. Les principales lesions responsables des cas d 'EPT etaient: les plaies crânio-cerebrales avec 9 cas (29,03%) suivi des embarrures (25,80%). Les autres lesions etaient les hematomes extraduraux avec 3 cas (9,68%), sous-duraux 4 cas (12,90%) les contusions et les hematomes intracerebraux chacun 1cas (3,23%) et les lesions mixtes 3 cas (9,68%). Conclusion: le TCE est une cause frequente d’epilepsie pouvant affecter la vie socioprofessionnelle des patients. La gravite du traumatisme, les lesions cerebrales a l’imagerie constituaient des facteurs de risque. Mots cles: epilepsie post-traumatique, lesions English Title: Posttraumitic epilepsia, our experience about 31 cases English Abstract The crânio-encephalic trauma constitutes a not insignificant cause of secondary epilepsy. The risk factors and the prevention are the object of controversy. No study had was led on the EPT to Mali. The objectives of our work are: the objectives of this work are: determine the frequency this affection, clear (release) the main responsible brain damages. Patients and methods: it was about a retrospective study from January 2009 till December 2010. Result: the study concerned 31 of the EPT on a total of 757 of the crânio-encephalic trauma that is 4, 10% of the cases. The male prevailed with 23 cases (74.19%) against 8 women (25, 81%). The maximum of case was registered in the edge of 21-25 years, an average age of 26 years with extremes 4 and 60 years. Etiology was dominated by the road traffic accident with 18 cases (58, 06%) followed by assault 9 cases (29.03%) among which 6 by Cold steels and 3 by guns. The falls and the knocks of clog represented respectively 3 cases (9.48%) and 1cas (3.23%). Glasgow was lower or equal to 8 (cranial trauma engraves (burns)) to 54.84%. The main responsible hurts were the close head injury with 9 cases (29.03%) depressed skull fracture (25.80%). Other hurts were extradural hematoma with 3 cases (9.68%), subdural hematoma 4 cases (12.90%) the bruises and intra parenchymal hematoma each 1cas (3.23%) and the mixed hurts 3 cases (9.68%). Conclusion: the TCE is a frequent cause of epilepsy which can affect the social and occupational life of the patients. The gravity of the trauma, the brain damages in the imaging constituted factors. Keywords: post-traumatic epilepsy, hurts
La mort subite est une mort instantanée ou rapide, d'origine naturelle, inattendue ou inopinée. Chez l'adulte les causes cardiovasculaires, pulmonaires et cérébrales prédominent. Son mode de survenue est dramatique. L'objectif était ici de déterminer les circonstances de survenue de ces morts subites, les facteurs de risque, d'identifier les causes de mort subite chez l'adulte à l'autopsie, en vue d'améliorer la prévention. Il s'agit d'une étude rétrospective portant sur les cas de morts subites ayant fait l'objet d'une autopsie au service d'anatomie pathologique de l'Hôpital Aristide Le Dantec (HALD) de Dakar du 1er janvier 2003 au 31 décembre 2005. Durant cette période 476 cas de morts subites chez l'adulte sur 1936 autopsies ont été enregistrés. Le sexe ratio est de 2,9 avec 356 hommes (74,8 %) et 120 femmes (25,2 %). Les cardiopathies ont été la première cause de décès dans notre série avec 177cas sur 476 soit 37,2 %. La prévention de la mort subite reste primordiale, surtout dans le contexte africain, où la prise en charge pré hospitalière est souvent défaillante.
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