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Mortality and Morbities of Severe Stroke in Limited Ressources Neurological Service 资源有限的神经科重症脑卒中的死亡率和发病率
Pub Date : 2019-06-29 DOI: 10.11648/J.CNN.20190302.15
K. Assogba, K. Apetse, Watouo Marlène Djobosse, L. Sonhaye, Nynèvi Anayo, Panabalo Waklatsi, Abdoulah Blakime, Victor Kokou Adjenou, K. Balogou
Introduction: Severe strokes have poor prognosis by their heavy motor and cognitive consequences. Objective: To describe the epidemiological, clinical and therapeutic aspects of these strokes. Material and Method: A retrospective and analytical study was conducted from January 2015 to December 2016 in the neurology department of our University Hospital. The diagnosis of severe stroke was based on clinical criteria (NIHSS score greater than 17, Glasgow score less than 9, and a WFNS stage greater than or equal to IV); and CT scan criteria (stroke location in the posterior fossa, carotid and Sylvian malignant infarction, cerebral hemorrhage with ventricular flood and mass effect). Results: We recorded 1964 strokes and 163 patients had severe stroke with a frequency of 8.3%. Of the 163 severe strokes, ischemic were observed in 38.7% and hemorrhagic for 61.3%. The average age was 55.8 ± 12.8. The motor deficit (76.1%) and disturbances of consciousness (62.6%) were the most admission signs. High blood pressure was the main risk factor (64.8%) and the etiology of hemorrhage in 83.5%. Atherosclerosis was the main etiology (86.4%) of ischemia. The hemorrhagic lesions location was diencephalic (67.7%) and brainstem (21.7%). Overall mortality was 44.8%, including 72.6% of early mortality due to haemorrhage. Predictive factors of mortality were the high NIHSS score, low Glasgow score, presence of ventricular flood, and high volume of hematoma. Conclusion: The high incidence of severe stroke and its early mortality rate demonstrate that many challenges remain to be done to improve the management of patients and avoid disabling sequelae.
严重中风由于其严重的运动和认知后果,预后较差。目的:了解该类脑卒中的流行病学、临床及治疗特点。材料与方法:对2015年1月至2016年12月在我校医院神经内科进行回顾性分析研究。重度脑卒中的诊断基于临床标准(NIHSS评分大于17分,格拉斯哥评分小于9分,WFNS分期大于或等于IV);CT扫描标准(脑卒中后窝部位、颈动脉及颈椎骨恶性梗死、脑出血伴脑室泛洪及肿块效应)。结果:本组共记录脑卒中病例1964例,其中重度脑卒中163例,发生率8.3%。163例重度脑卒中中,缺血性占38.7%,出血性占61.3%。平均年龄55.8±12.8岁。运动障碍(76.1%)和意识障碍(62.6%)是最常见的入院体征。高血压是主要危险因素(64.8%),出血是主要病因(83.5%)。动脉粥样硬化是缺血的主要病因(86.4%)。出血性病变部位为间脑(67.7%)和脑干(21.7%)。总死亡率为44.8%,包括72.6%因出血导致的早期死亡率。死亡率的预测因素是NIHSS评分高、格拉斯哥评分低、心室充血和血肿量大。结论:重型脑卒中的高发病率和早期死亡率表明,在改善患者管理和避免致残后遗症方面仍有许多挑战要做。
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引用次数: 0
Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka 达卡神经科学研究所转诊卒中患者低钠血症的频率和类型
Pub Date : 2019-06-21 DOI: 10.11648/J.CNN.20190302.14
M. A. Hakim, Mashfiqul-Hasan, Mahmudul Islam, Mohammad A. Hossain, J. Naznin, Saifur R. Khan
Background: Hyponatremia is a common electrolyte abnormality in acute stroke patients and may be related to variable etiology. Objective: To observe the frequency and types of hyponatremia in hospitalized acute stroke patients. Materials and methods: This cross-sectional study, carried out in a referral neuroscience institute of Dhaka during February to November 2017, included 209 patients admitted with acute stroke (65 ischemic, age 61.5±13.3 years, M/F: 45/20; 144 hemorrhagic, age 59.2±13.1 years, M/F: 80/64). The clinical and laboratory values on admission were recorded. Those having hyponatremia (serum sodium <135 mmol/L) on admission were evaluated by clinical features (history of vomiting or diarrhoea, volume status, urine output) and laboratory parameters (urine osmolality, urine sodium, plasma osmolality, blood urea, hematocrit) to determine the types of hyponatremia. Results: Four patients died before the serum could be sent for electrolytes. Among the rest, 36 (17.6%) had hyponatremia on admission. Serum sodium level was <125 mmol/L in 7 (19.4%) and 125-134 mmol/L in rest of the patients having hyponatremia (29; 80.6%). The frequency of hyponatremia was similar in ischemic and hemorrhagic stroke (17.2% vs. 17.7%, p=0.925). Syndrome of inappropriate antidiuresis (SIAD) was most frequent cause of hyponatremia (50.0%), followed by cerebral salt wasting (CSW; 30.6%). The rest had either hyponatremia related to gastrointestinal (GI) fluid loss (2.8%) or died before a cause of hyponatremia could be ascertained (11.1%). There was no significant difference of age, gender, NIHSS score and GCS score on admission as well as in hospital stay and in-hospital mortality between patients with or without hyponatremia (p=ns for all). Frequency of CSW was relatively higher in hemorrhagic stroke (hemorrhagic vs. ischemic: 32.0% vs. 27.3%) and SIAD in ischemic stroke (hemorrhagic vs. ischemic: 40.0% vs. 72.7%) but did not reach level of statistical significance. Conclusion: Frequency of hyponatremia seems remarkable in hospitalized acute stroke patients, SIAD and CSW being the most frequent cause.
背景:低钠血症是急性脑卒中患者常见的电解质异常,可能与多种病因有关。目的:观察急性脑卒中住院患者低钠血症的发生频率和类型。材料与方法:本横断面研究于2017年2月至11月在达卡一家转诊神经科学研究所进行,纳入209例急性脑卒中患者(65例缺血性,年龄61.5±13.3岁,M/F: 45/20;出血144例,年龄59.2±13.1岁,M/F: 80/64)。记录入院时的临床和实验室值。入院时患有低钠血症(血清钠<135 mmol/L)的患者通过临床特征(呕吐或腹泻史、容量状况、尿量)和实验室参数(尿渗透压、尿钠、血浆渗透压、尿素、红细胞压积)进行评估,以确定低钠血症的类型。结果:4例患者在血清送电解质前死亡。其中入院时低钠血症36例(17.6%)。7例(19.4%)患者血清钠水平<125 mmol/L,其余低钠血症患者血清钠水平在125-134 mmol/L之间(29例;80.6%)。缺血性卒中和出血性卒中低钠血症发生率相似(17.2%比17.7%,p=0.925)。不适当抗利尿综合征(SIAD)是低钠血症最常见的原因(50.0%),其次是脑盐消耗(CSW;30.6%)。其余的患者要么患有与胃肠道(GI)体液流失相关的低钠血症(2.8%),要么在低钠血症病因明确之前死亡(11.1%)。有无低钠血症患者的年龄、性别、入院时NIHSS评分、GCS评分、住院时间和住院死亡率均无显著差异(p=ns)。CSW在出血性卒中(出血性vs缺血性:32.0% vs. 27.3%)和SIAD在缺血性卒中(出血性vs.缺血性:40.0% vs. 72.7%)中的发生率相对较高,但未达到统计学意义水平。结论:住院急性脑卒中患者低钠血症发生率显著,其中SIAD和CSW是最常见的病因。
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引用次数: 0
Patient with Refractory Epilepsy Associated with Oligondendroglioma 伴少突胶质细胞瘤的难治性癫痫患者
Pub Date : 2019-06-21 DOI: 10.11648/J.CNN.20190302.13
Mauricio Vaillant Amarante, Ozinelia Pedroni Batista, Camilia Lampier Lutzke, Shirley Kempin Quiqui
Oligodendroglioma is a rare form of primary brain tumor, accounting for about 2-5% of intracranial tumors, being more common in adult males but rare in children, accounting for about 1-2% of all primary brain tumors in children. It originates from oligodendrocytes or glial precursor cells and exhibits infiltrative and slow growth. They can be classified in two grades (Grade II and Grade III), where Grade II are low grade tumors and have tumor cells that grow slowly and invade nearby normal tissue, and Grade III are malignant and have rapidly growing tumors. It has low growth and 50-80% of cases first symptom is seizures. A seizure is a symptom that requires a rapid solution usually requiring empirical treatment at the initial time to cease seizures and promote some well-being for the patient's routine. Seizures can cause a lot of damage to the patient's life, especially if the patient is a child who does not know what to do and what to do. Depending on the intensity and frequency of seizure episodes, the patient may experience fractures with falls, may suffer discrimination and prejudice at school. The causes behind refractory epilepsy are diverse, so whenever a patient is found to be refractory to drug treatment, the origin of seizures should be investigated early, it is not enough to stop at empirical treatment.
少突神经胶质瘤是一种罕见的原发性脑肿瘤,约占颅内肿瘤的2-5%,多见于成年男性,在儿童中罕见,约占儿童原发性脑肿瘤的1-2%。它起源于少突胶质细胞或胶质前体细胞,具有浸润性,生长缓慢。可分为II级和III级,II级为低级别肿瘤,肿瘤细胞生长缓慢,侵袭附近正常组织;III级为恶性肿瘤,肿瘤生长迅速。它生长缓慢,50-80%的病例的第一症状是癫痫发作。癫痫发作是一种需要快速解决的症状,通常需要在最初进行经验性治疗以停止癫痫发作并促进患者日常生活的一些健康。癫痫发作会对患者的生活造成很大的伤害,特别是如果患者是一个不知道该怎么做和该怎么做的孩子。根据癫痫发作的强度和频率,患者可能会因跌倒而骨折,可能在学校受到歧视和偏见。难治性癫痫背后的原因是多种多样的,因此,每当发现患者对药物治疗难治性时,应及早调查癫痫发作的起源,仅止于经验性治疗是不够的。
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引用次数: 0
Neurological Disease Surveillance in Cameroon, a Rural and Urban-Based Inout Patient Population Study 喀麦隆的神经系统疾病监测,一项基于农村和城市的外来患者人口研究
Pub Date : 2019-05-31 DOI: 10.11648/J.CNN.20190301.15
J. Doumbe, Y. Mapoure, T. Nyinyikua, C. Kuate, K. Kompoliti, Hiral Shal, Bichum Ouyang, S. Calvo, Abel Fernandez-Sierra, E. Cubo
Background: There is a paucity of literature on the burden of neurological diseases in sub-Saharan Africa. Objective: To create a registry and surveillance of neurological diseases from urban and rural health centers in Cameroon. Methods: Retrospective review of medical records of inpatients and outpatients from two urban public hospitals in Douala and two rural health care centers, from 2013 to 2015 was conducted. In the urban areas, the diagnosis was made by a neurologist but this was not the case in the rural areas. The following variables were analyzed: demographics, medical center characteristics, presenting neurological complaint, medical history, neurological diagnosis, death and disability. Neurological diseases were classified according to ICD-10. Results: Out of 20,131 medical charts available (13% from the rural area), 4,187 cases (20.7%) with neurological complaints were identified and reviewed, mean age 48.67 + 18.62 years, females 54.7%, 188 children (4.4%). The most frequent neurological complaints were: paresis/weakness (G.82, 25.2%) and headache (R.51, 22.0%). The most common concurrent medical history was hypertension (I10, 40.0%), and HIV (B20, 16.45%). The most common neurological diagnoses were cerebrovascular disease (G45, G46, 51.5%), and infection (B50, G00, G04, G06, 24.13%) in adults, and epilepsy (G40, 64.0%) in children. Death due to neurological cause was recorded in 428 patients (19.1%), and disability in 1,072 (57.2%). Neurodegenerative diseases were exclusively diagnosed in urban areas. Conclusion: Population aging and changes in the distribution of risk factors have accelerated the prevalence of non-communicable diseases such as cerebrovascular disease. However, additional work to characterize the nature of diagnosis, treatment and care is important to advance quality of care in the adult and pediatric neurological disorders. A health policy geared towards prevention and neurological training for health professionals is warranted.
背景:关于撒哈拉以南非洲地区神经系统疾病负担的文献很少。目的:建立喀麦隆城乡卫生中心神经系统疾病的登记和监测系统。方法:回顾性分析杜阿拉两所城市公立医院和两所农村卫生院2013 - 2015年住院和门诊患者的病历资料。在城市地区,诊断是由神经科医生做出的,但在农村地区并非如此。分析以下变量:人口统计学、医疗中心特征、出现神经系统疾病、病史、神经系统诊断、死亡和残疾。根据ICD-10对神经系统疾病进行分类。结果:在可查病历20131份(13%来自农村地区)中,发现并复核神经系统疾患4187例(20.7%),平均年龄48.67 + 18.62岁,女性54.7%,儿童188例(4.4%)。最常见的神经系统主诉为:神经麻痹/虚弱(G.82, 25.2%)和头痛(R.51, 22.0%)。最常见的合并病史为高血压(I10, 40.0%)和HIV (B20, 16.45%)。最常见的神经学诊断为脑血管病(G45, G46, 51.5%),成人感染(B50, G00, G04, G06, 24.13%),儿童癫痫(G40, 64.0%)。428例(19.1%)患者因神经系统原因死亡,1072例(57.2%)患者残疾。神经退行性疾病仅在城市地区得到诊断。结论:人口老龄化和危险因素分布的变化加速了脑血管病等非传染性疾病的流行。然而,进一步确定诊断、治疗和护理性质的工作对于提高成人和儿童神经系统疾病的护理质量非常重要。有必要制定一项面向预防和对卫生专业人员进行神经学培训的卫生政策。
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引用次数: 1
Neurological Complications of Myeloproliferative Syndromes with Negative Philadelphia Chromosome (MPS Ph-) in Lome Tertiary Hospital 洛美三级医院费城染色体阴性骨髓增生性综合征的神经系统并发症
Pub Date : 2019-05-27 DOI: 10.11648/J.CNN.20190301.13
K. Assogba, Kodzo Vinyo Kumako, K. Apetse, E. Padaro, A. Balaka, Abdoullaye Idrissou, Komi I Agbotsou, Nyenèvi Komla Anayo, Abdullah Blakime, A. Balogou
Introduction: Myeloproliferative syndromes with philadelphia (MPS Ph) chromosome negative are diseases little known in our environment and cause grave neurological sequels. The study aimed to describe the neurological complications of these syndromes. Patients and method: It was a retrospective cross-sectional study carried out on the files of patients follow up or hospitalized in hematology or neurology departments of our tertiary hospital from January, 2008 to December, 2017. The variables analyzed were composed of epidemiological data, clinical signs, treatments used, neurological complications, and evolution. Results: Among 39 patients with MPS Ph negative, 30 (76.9%) had neurological complications at the time of diagnostic. Headaches, dizziness and splenomegaly were the most reported clinical signs in 95.2%, 73.6% and 66.7% respectively. Different types of MPS Ph negative were observed with 21 cases of polycythemia vera, 8 cases of essential thrombocythemia and one case of primary myelofibrosis. The research of Jack2V617F mutation was made in 25 patients (83.3%) and was positive in 15. The neurological complications were marked by peripheral neuropathy (20 cases), cerebral venous thrombosis (15 cases) and ischemic stroke in 11 cases. The average length of stay in hospital was 23.6 days. Concerning the treatment, 96.7% had received antiplatelet therapy and cytoreductive treatment was added in 66.7%. The outcome was marked by the remission of symptoms in 11.1% of cases, 46.7% with sequels and 20% of death. Conclusion: The MPS Ph negative patients are often discovered in late stage of the disease progression with neurological complications. Measures need to be taken to improve the early diagnosis and management of MPS Ph chromosome negative.
骨髓增生性综合征伴费城(MPS Ph)染色体阴性是一种在我们的环境中鲜为人知的疾病,可引起严重的神经系统后遗症。该研究旨在描述这些综合征的神经系统并发症。患者与方法:对2008年1月至2017年12月在我院血液科或神经内科随访或住院的患者档案进行回顾性横断面研究。分析的变量包括流行病学数据、临床体征、使用的治疗方法、神经系统并发症和演变。结果:39例MPS Ph阴性患者中,30例(76.9%)在诊断时存在神经系统并发症。头痛、头晕和脾肿大是报告最多的临床症状,分别占95.2%、73.6%和66.7%。真性红细胞增多症21例,原发性血小板增多症8例,原发性骨髓纤维化1例。25例(83.3%)研究了Jack2V617F突变,15例阳性。神经系统并发症以周围神经病变(20例)、脑静脉血栓形成(15例)和缺血性脑卒中(11例)为主。平均住院时间为23.6天。在治疗方面,96.7%的患者接受了抗血小板治疗,66.7%的患者加用了细胞减少治疗。结果显示,11.1%的病例症状缓解,46.7%有后遗症,20%死亡。结论:MPS Ph阴性患者多出现在疾病进展晚期,伴有神经系统并发症。需要采取措施提高MPS Ph染色体阴性的早期诊断和处理。
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引用次数: 0
Hydrocephalus and Spasticity in Motor Area AVM, a Case Report AVM运动区脑积水及痉挛1例
Pub Date : 2019-05-15 DOI: 10.11648/J.CNN.20190301.12
Veranis Sotiri, Papageorgiou Demetrios, Mpazinas Theodoros, Lagios Konstantinos
Obstructive hydrocephalus is a rare complication of brain AVM’s. It usually diagnosed because of posterior fossa AVM’s. This article is about a case of a 40-year-old female patient suffering from a right fronto-parietal unruptured grade IV AVM located in the central sulcus who developed obstructive hydrocephalus and worsening of left sided weakness and spasticity. The AVM has been embolized twice in the past and no further treatment was offered because of the adjacent motor cortex and concerns of permanent neurological damage. Patient was treated with navigated ventricular-peritoneal shunt with a programmable valve. Interestingly there was an improvement of spasticity and weakness.
梗阻性脑积水是脑动静脉畸形的罕见并发症。通常诊断为后颅窝AVM。本文报道一例40岁女性患者,其右侧额顶叶未破裂的IV级AVM位于中央沟,发展为梗阻性脑积水,左侧无力和痉挛恶化。动静脉畸形过去曾被栓塞过两次,由于邻近的运动皮层和对永久性神经损伤的担忧,没有进一步的治疗。患者采用可编程瓣膜导航脑室-腹膜分流术治疗。有趣的是,痉挛和虚弱都得到了改善。
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引用次数: 0
Rare Cause of Facial Nerve Palsy (Petrous Apex Cholesteatoma)–Case Report and Review of Literature 面神经麻痹罕见病因(岩尖胆脂瘤)1例报告及文献复习
Pub Date : 2019-05-11 DOI: 10.11648/J.CNN.20190301.11
R. Ahmed, Owais Makhdoomi, O. Shafi, Faheem Khalid
The petrous apex is a pyramid-shaped struc­ture that is formed by the medial portions of the temporal bone. It is obliquely positioned within the skull base, with its apex pointing anteromedially and its base located postero­laterally. The petrous apex is bounded by the inner ear structures laterally, the petro-occipital fissure medially, the petrosphenoidal fissure and ICA anteriorly, and the posterior cranial fossa behind. Given its location, the petrous apex is susceptible to multiple pathologic processes which may be Inflammatory, developmental, vascular, benign and malignant lesions. We present a rare case of a 39 year old Male who presented wit unilateral facial nerve palsy and sensoneural hearing loss and was then diagnosed as petrous apex Cholesteatoma. Patient was treated surgically by Transchoclear trasnlabrynth technique.
岩尖是一个金字塔状的结构,由颞骨的内侧部分形成。它斜位于颅底内,其尖端指向前内侧,其基部位于后外侧。岩尖外侧为内耳结构,内侧为枕岩裂,前方为蝶岩裂和ICA,后方为颅后窝。由于其位置,岩尖易受多种病理过程的影响,可能是炎症、发育、血管、良性和恶性病变。我们报告一个罕见的病例,39岁男性,他表现为单侧面神经麻痹和感觉性听力丧失,然后被诊断为岩状顶点胆脂瘤。患者采用经核超声技术进行手术治疗。
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引用次数: 0
Profile of Swallowing Disorders in Acute Stroke in Brazzaville 布拉柴维尔急性脑卒中患者吞咽障碍概况
Pub Date : 2019-01-01 DOI: 10.11648/j.cnn.20190301.14
Ghislain Armel Mpandzou
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引用次数: 0
Selected Physical Therapy Program for Balance Training of Neuropathic Patients After Lower Limb Burn 下肢烧伤后神经病变患者平衡训练的物理治疗方案选择
Pub Date : 2019-01-01 DOI: 10.11648/j.cnn.20190302.12
Rasha Mohamed El-Rewainy
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引用次数: 0
Large Intra-Osseous Cystic Meningioma in a Child: A Rare Entity 儿童骨内巨大囊性脑膜瘤:罕见病例
Pub Date : 2019-01-01 DOI: 10.11648/j.cnn.20190302.11
Denléwendé Sylvain Zabsonre
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引用次数: 0
期刊
Journal of clinical neurology and neuroscience
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