Post-stroke seizures: risk factors and management after ischemic stroke

Stroke is the leading cause of epilepsy in the elderly, ahead of degenerative diseases, tumors and head injuries. It constitutes a significant complication and a considerable comorbidity. The aim of our study was to describe the main factors implicated in the occurrence of post-stroke seizures and to identify the predictors of seizure recurrence. We conducted a descriptive, retrospective, monocentric study from January 2010 to December 2019, including patients who presented seizures following an ischemic stroke. We classified these seizures according to the International League Against Epilepsy (ILAE) into acute symptomatic seizures (ASS) if they occur within seven days of stroke, and unprovoked seizures (US) if they occur after more than one week. Clinical, para-clinical, therapeutic and follow-up data were statistically analyzed and compared. A total of 52 patients were included (39 men, 13 women; median age 55.1 years). 21 cases (40%) had ASS and the remaining 31 cases (60%) presented US. Young age below 65 years (71%), middle cerebral artery infarcts (83%), and cortical localization (87%) were the main factors depicted in our series. Parietal lobe infarction was more associated with US than ASS (p = 0.035). 24 patients (46%) have presented a recurrence of seizures (8/21 of ASS and 16/31 of US). The use of sodium valproate in monotherapy was identified as a recurrence risk factor (p = 0.013). In patients with post-stroke seizures, parietal lobe infarcts are more associated with US. We identified a higher risk of seizure recurrence in patients treated with sodium valproate monotherapy.

Sclérose en plaques et Covid-19 : interactions entre les vaccins du Covid-19 et la Disease Modifying Therapy (DMT), étude d’une cohorte monocentrique

Introduction

La SEP bénéficie d’un traitement de fond qui modifie le fonctionnement du système immunitaire. Durant la pandémie du Covid-19, cette population était exposée au dilemme d’un virus et vaccination inconnus.

Objectifs

Décrire l’association SEP et infection au Covid-19. Identifier la réponse vaccinale en fonction du taux sérique des anticorps du Covid-19.

Patients et méthodes

Nous avons mené une étude prospective monocentrique incluant 30 patients atteints de SEP dans ses différentes formes cliniques. Le diagnostic positif s’est basé sur les critères de Mc Donalds 2017. Un interrogatoire fondé sur les définitions alternatives de l’OMS sur l’infection au Sars-Cov-2 a été réalisé afin de rechercher les symptômes typiques. Tous ont bénéficié d’un RT-PCR sur écouvillon nasopharyngé et d’une sérologie du Covid-19 en utilisant la technique de chimiluminescence.

Résultats

L’âge moyen était de 35,8 ans. La prévalence de l’infection Covid était de 39,2 % avec 100 % de forme clinique légère. Toutefois, 77,7 % étaient déjà vaccinés dont 66,7 % sous immunosuppresseurs (IS) et 33,3 % sous immunomodulateurs (IM) avec une durée moyenne de traitement de 4,9 ans. La sérologie IgG était positive chez 58,3 % des SEP vaccinés après un délai moyen de 50,8 jours. Le taux moyen d’IgG chez les patients sous (IS) et (IM) était respectivement de 109,4 UI/mL et 33,9 UI/mL.

Discussion

La prévalence de l’infection au Sars-Cov-2 chez nos patients rejoint celle de la population générale. Uniquement des cas d’infection légère ont été retrouvés chez nos patients et ce malgré les DMT suggérant une action protectrice par l’inhibition de la cascade cytokiniques responsables des tableaux graves. La présence d’IgG insinue qu’il existe peu d’effets des DMT sur l’immunité humorale.

Conclusion

Les patients SEP n’ont pas à modifier ou suspendre leur traitement de fond. L’immunité humorale induite par le vaccin parait conservée indépendamment des DMT préconisés.

Early pregnancy-associated ischemic stroke during first trimester in a young woman: A case report

Pregnancy-associated ischemic stroke is rare. The degree of the risk is the highest in the third trimester, but clinicians should be also wary from the beginning of the pregnancy as the risk still exists like demonstrated by our case.

Isolated Cervical Pain Revealing a Common Carotid Artery Dissection in a Child Following a Minor Trauma: A First Pediatric Case Report and a Review of the Literature

Background

Cervical artery dissections are not exceptional in the pediatric population. Typically, it affects the internal carotid artery or the vertebral artery. To our knowledge, this is the first case of common carotid artery (CCA) dissection in a child.

Case

We present a case of a 7-year-old-boy admitted to our neurology department complaining of cervical pain after a minor neck trauma. The neurological examination was normal. The ultrasound showed a mural hematoma with an intimal flap. The magnetic resonance angiography revealed an irregular segment of the left CCA just before its bifurcation. The diagnosis of an acute dissection on the left CCA was confirmed and antiplatelet therapy was started.

Conclusion

The diagnosis of cervical artery dissections remains a challenge because of its variable clinical presentation. It should be suspected in the context of neck trauma and treatment should be initiated rapidly to reduce the risk of ischemic stroke.

Monocentric study of 28 cases of chronic inflammatory demyelinating polyneuropathy: first Tunisian study

BACKGROUND

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare affection of the peripheral nervous system. Its diagnostic criteria have evolved since 1975. The aim of our work is to study the epidemiological, clinical, and paraclinical aspects of CIDP.

METHODS

We conducted a retrospective study of 28 CIDP patients of the neurology department of the military hospital of Tunis between January 2000 and December 2017. All these patients met the European Federation of Neurological Societies/Peripheral Nerve Society(EFNS/PNS)2010 diagnostic criteria for definite CIDP.

RESULTS

The average age was 50 years with a gender ratio of 1.57. We found sensitivomotor symptoms in 66% of patients. Neurological assessment showed a proximal and distal motor weakness in 50% of cases, the involvement of superficial and deep sensory systems in 44% of patients with a generalized areflexia in all patients. Median Inflammatory Neuropthy Cause and Treatment (INCAT) score was 7. Concerning electrophysiology, all our patients met the EFNS/EPS 2010 diagnostic criteria for a definite CIDP. Screening for concurrent pathologies was positive in 11 patients. On the therapeutic side, there was no superiority of intravenous immunoglobin compared with pulsed methylprednisolone. Oral steroids were used as backup in about 50% of patients. There were good outcomes in 72% of patients who improved very well after treatment.

CONCLUSION

CIDP is a rare and polymorphic disorder with a variety of concurrent pathologies. Our study is the first study in Tunisia and in Maghreb countries which included the most big series of patients. Our results were similar to literature. A multicentral study would be better profitable.

Accident vasculaire cérébral inaugural d’une infection COVID-19 : étude de 9 cas

Introduction

Malgré son tropisme respiratoire et cardiovasculaire, une relation non négligeable entre le nouveau coronavirus 2019 (SARS-CoV-2) et le système neurovasculaire a été décrite.

Objectifs

L’objectif de notre travail était d’étudier les caractéristiques cliniques et pronostiques des accidents vasculaires cérébraux (AVC) chez les patients infectés par le SARS-COV-2.

Patients et méthodes

Nous avons mené une étude rétrospective descriptive incluant 9 patients suivis au service de neurologie de l’hôpital militaire principal d’instructions de Tunis pour accident vasculaire cérébral aigu et présentant une infection par le SARS-CoV-2 diagnostiquée à l’aide d’une réaction en chaîne par polymérase transcriptase inverse (RT-PCR) sur des écouvillons nasopharyngés.

Résultats

Nous avons colligé 9 patients (7 hommes et 2 femmes). L’âge moyen était de 64 ans. Les sous-types d’AVC étaient ischémiques (6 cas) hémorragique (1 cas), et une thrombose veineuse cérébrale (1 cas). Tous les patients avaient au moins 2 facteurs de risque vasculaires. Le score NIHSS moyen était de 16 ± 5. Le pronostic était péjoratif chez la plupart des patients (3 patients étaient décédés et 3 autres ont gardé un handicap sévère).

Discussion

Peu de publications ont étudié les AVC faisant suite à la maladie COVID-19. Plusieurs mécanismes physiopathologiques ont été décrits tels que l’inflammation, l’hypoxie tissulaire et les vascularites. Conformément à la littérature, les AVC chez les patients COVID-19 semblent souvent plus graves par rapport aux AVC survenant chez les personnes non infectées par le sars-CoV-2.

Conclusion

Vu l’impact pronostique défavorable posé par les AVC survenant chez des patients COVID-19, des recherches supplémentaires sont nécessaires à fin d’optimiser leurs prises en charge diagnostique et thérapeutique.

Acute-onset chronic inflammatory demyelinating polyneuropathy with cranial nerves and respiratory tract involvement: A case report

Sixteen percent of chronic inflammatory demyelinating polyneuropathy (CIDP) patients may present acutely like acute idiopathic demyelinating polyneuropathy (AIDP) the demyelinating form of GBS, developing in <8 weeks 2. This entity is classified as acute-onset CIDP (A-CIDP) which presents overlapping clinical and electrophysiological findings with GBS during early stages of disease, but followed with a chronic course beyond 2 months. Also, those who have three or more treatment-related fluctuations (TRF) are included under this term. Distinguishing between acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) and acute idiopathic demyelinating polyneuropathy (AIDP) may be difficult during early stages but is crucial in order to guide treatment strategies without delay. These two forms share some overlapping clinical and electrophysiological findings, including some severe clinical features such as cranial nerve and respiratory tract involvement making the diagnosis of A-CIDP more difficult.

An atypical form of chronic inflammatory demyelinating polyneuropathy presenting with initial isolated bulbar weakness

The article's abstract is not available.