0833 Post-malaria neurological syndrome: a case report
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$312 Wednesday, November 9, 2005 Poster Abstracts 0831 Tuberculosis in Neurology Department in Marrakech (41 Cases) Louhab N ~, Asbai K ~, Jafoui M ~, Ayadi F 2, Ait Benali S 2, Kissani N ~ . 2Neurology department; 2 Neurosurgery department CHU Mohammed VI Marrakech, Morocco Background: In Morocco tuberculosis in general and particularly of nervous system is not rare and still constitutes a medical health problem meanwhile of the generalization of the vaccination. Method: Authors analyzed retrospectively 41 observations of central nervous system tuberculosis, collected in neurology department of Marrakech during 3 years (from January 2002 to February 2005) in order to analyze epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of central nervous system tuberculosis in Marrakech. Results: There were 29 females and 12 males, mean age was 41 years and 60°,5 were rural. The lapse between onset of ssanptoms and consultation varied from 2 months to 1 year. The clinical manifestation was dominated by spinal cord compression in 23 cases and intracranial hypertension in 10 cases. Cerebral CT scan was realized in 14 cases, encephalic and spinal cord MRI in 4 cases. The most common presentation was Pott's disease with neurological complications (23 cases), brain tuberculoma (5), merfingoencephalitis (16), menJngonrye- litis (12) and basilar merfingitis (3). HIV co infection was presented in 2 cases of tuberculoma. In 4 cases there was pulmonary localization and peritoneal in one. All our patients received anfituberculosis drugs during 9 months (2SHRZ/7RH), corticotherapy (112 cases) and specific surgical treat- merit (20 cases). The outcome was good in 39 cases and 2 cases with AIDS dead. Conclusion: Tuberculosis still frequent in neurology and neurosurgery, this is due to lack of access to the health system in the countryside and low socioeconomJcal level in Marrakech region. 0832 Neurosyphilis in Southern Morocco About 72 Cases Lonhab, N, Jafoui, M, Hamdi, J, Kissani, N. Neurology department, CHU iVloharnrned 1~7 Marrakeeh, Morocco Background: In Morocco syphilis in general and particularly of nervous system still constitutes a medical health problem. The aim of study is to analyze epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of neurosyphilis in South Morocco. Methods: Authors analyzed retrospectively 72 observations of neuro- syphilis, collected in neurology department of Marrakech during 11 years (11994 to 2004). Results: These 72 patients constitute 5°,5 of all neurology deparmrents' hospitalization. Mean age was 41 years, 89°,5 were male, 51,4% were rural. The delay of consultation varied from 2 months to 7 years. We found the most common presentation to be meningio encephalitis (chronic. in 31 cases and acute in 8), tabes dorsalis (113), meningio arteritis (4), optic atrophy (5), myelitis (15), striatitis (3), late congerfital syplfilis, anryotrophic lateral sclerosis and neurosyptfilis associated with neurobehcet disease, one case each. Blood VDRL was positive in all cases and in 87,5?,'0 of CSF, TPHA were positive either in blood and CSF in all cases. The CT scan realized in 24 patients and the MRI in 3 patients, they showed in the majority a cortical atrophy. All our patients received cures of penicillin during 10 days repeated 4 times and there was a good recovery in 13% and stabilization in 83°,5. Conclusion: Authors analyze and try to better understand the profile of neurosyphilis in South Morocco, and some hypothesis are given in having Neurosyphilis after untreated chancre in some patients and not in others. 0833 Post-Malaria neurological syndrome: a case report Marchini, C l, Ferracci, F ~, Zambito Marsala S ~, Cecotfi, L a, Gentile, M 1, C.onte, F ~, Candeago, RM 1. 1Unitd Operativa di Neurologia, Ospedale San Martino di Belluno, Belluno, haly; 2Cattedra di Neurologia, DPMSC, Universitd degli Studi di Udine, Udine, Italy Post-Malaria Neurological Syndrome (PMNS) is a rare condition following recovery from a usually severe episode of Plasmodium faldparum malaria. It is characterized by acute confusional state or psychosis and non-specific neuropsyckiatric signs, including inap- propriate behaviour, speech disorders, generalized convulsions, visual hallucinations, fine limb tremor and catatorfia. Mefloquine treatment of the preceding malaria episode has been assodated with PMNS. Patients usually don't develop focal neurological signs and recover spontaneously. Until now, only one case of PMNS has been reported in the Westenr hemisphere. We describe the case of a 60-year-old Italian man, who developed a severe form of P. falciparunr malaria after being in French Guinea. He was treated with Quinine, Doxycycline and Ceftrimxone. Nine days after recovering, he developed generalized weakness, limb tremors, shivering and dizziness. Subsequently, he became disoriented to time and space, confused and aphasic. Blood examinations showed no parasites. Apart from motor aphasia, he showed no neurological focal signs. He remained confused and aphasic for 3 days. No lesion was demonstrated in brain CT and MRI scans. Lumbar puncture showed an increased protein content (1252 mg/dL), and 10 lymphocytes/ microL, suggesting that PMNS could be considered an acute inflanunatory encephalopathy. To our knowledge, tiffs is the first European case of PMNS. We believe neurologists should consider PMNS in the differential diagnosis of a patient who has recently recovered from P. faldparum malaria and presents with sudden confusional or psychotic states. 0834 HTLVdI: A Cohort of Brazilian Patients M. Menna-Barreto. Divison of Neurology, PUCRS, Porto Alegre, Brazil Background: Although the role of HTLV-II in human disease has yet to be clearly defined, there is growing evidence that, like HTLV-I, infection may also be associated with neurological disorders. Methods: We studied a cohort of 22 HTLV-If-infected individuals using three scores on the Expanded Disability Status Scale (EDSS), with higher scores indicating more severe disability. Statistical analysis was done by Kaplan-Meier method. Results: 22 HTLV-II-infected patients were followed during 94 months: 12 females and 10 males; median age 37.5 years; 50% Caucasians, 22.7?,'0 Afro-Brazilians, 18.2% mulattos and 9.1% Amerindians. At the end of the study, 63.6?,'0 of the patients have reached EDSS score of 3.5, 13.6"/o a score of 6 and 4.5°,5 a score of 8. Time from onset of neurological symptoms to assigmnent of a score of 3.5 in EDSS scale was 49.1 months (195°,5 CI; 32.9 to 65.3), to assigmnent of a score of 6 in EDSS scale was 86.1 months (1957,'o CI; 76.6 to 95.6) and to score of 8 in EDSS scale was 92.6 months (195% CI; 87.8 to 97.2). Urinary symptoms were the first (150%) and the most common complaints (190.9"/o). The neurological exanfination disclosed mainly deep sensory sense disturbances (95.4°,5) and pyramidal sylrdrome (54.5%). Conclusion: This cohort study has demonstrated low and increasing grades of disability among HTLV-If-infected individuals, supporting an association with neurological disease. 0835 Molecular Analysis of Measles Virus Genome Derived From SSPE and Acute Measles Patients in Papua New Guinea
Transcript of 0833 Post-malaria neurological syndrome: a case report
$312 Wednesday, November 9, 2005 Poster Abstracts
0831 Tuberculosis in Neurology Department in Marrakech (41 Cases)
Louhab N ~, Asbai K ~, Jafoui M ~, Ayadi F 2, Ait Benali S 2, Kissani N ~ . 2Neurology department; 2 Neurosurgery department CHU Mohammed VI Marrakech, Morocco
Background: In Morocco tuberculosis in general and particularly of nervous system is not rare and still constitutes a medical health problem meanwhile of the generalization of the vaccination. Method: Authors analyzed retrospectively 41 observations of central nervous system tuberculosis, collected in neurology department of Marrakech during 3 years (from January 2002 to February 2005) in order to analyze epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of central nervous system tuberculosis in Marrakech. Results: There were 29 females and 12 males, mean age was 41 years and 60°,5 were rural. The lapse between onset of ssanptoms and consultation varied from 2 months to 1 year. The clinical manifestation was dominated by spinal cord compression in 23 cases and intracranial hypertension in 10 cases. Cerebral CT scan was realized in 14 cases, encephalic and spinal cord MRI in 4 cases. The most common presentation was Pott 's disease with neurological complications (23 cases), brain tuberculoma (5), merfingoencephalitis (16), menJngonrye- litis (12) and basilar merfingitis (3). HIV co infection was presented in 2 cases of tuberculoma.
In 4 cases there was pulmonary localization and peritoneal in one. All our patients received anfituberculosis drugs during 9 months (2SHRZ/7RH), corticotherapy (112 cases) and specific surgical treat- merit (20 cases). The outcome was good in 39 cases and 2 cases with AIDS dead. Conclusion: Tuberculosis still frequent in neurology and neurosurgery, this is due to lack of access to the health system in the countryside and low socioeconomJcal level in Marrakech region.
0832 Neurosyphilis in Southern Morocco About 72 Cases
Lonhab, N, Jafoui, M, Hamdi, J, Kissani, N. Neurology department, CHU iVloharnrned 1~7 Marrakeeh, Morocco
Background: In Morocco syphilis in general and particularly of nervous system still constitutes a medical health problem. The aim of study is to analyze epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of neurosyphilis in South Morocco. Methods: Authors analyzed retrospectively 72 observations of neuro- syphilis, collected in neurology department of Marrakech during 11 years (11994 to 2004). Results: These 72 patients constitute 5°,5 of all neurology deparmrents' hospitalization. Mean age was 41 years, 89°,5 were male, 51,4% were rural. The delay of consultation varied from 2 months to 7 years. We found the most common presentation to be meningio encephalitis (chronic. in 31 cases and acute in 8), tabes dorsalis (113), meningio arteritis (4), optic atrophy (5), myelitis (15), striatitis (3), late congerfital syplfilis, anryotrophic lateral sclerosis and neurosyptfilis associated with neurobehcet disease, one case each. Blood VDRL was positive in all cases and in 87,5?,'0 of CSF, TPHA were positive either in blood and CSF in all cases. The CT scan realized in 24 patients and the MRI in 3 patients, they showed in the majority a cortical atrophy. All our patients received cures of penicillin during 10 days repeated 4 times and there was a good recovery in 13% and stabilization in 83°,5. Conclusion: Authors analyze and try to better understand the profile of neurosyphilis in South Morocco, and some hypothesis are given in having Neurosyphilis after untreated chancre in some patients and not in others.
0833 Post-Malaria neurological syndrome: a case report
Marchini, C l, Ferracci, F ~, Zambito Marsala S ~, Cecotfi, L a, Gentile, M 1, C.onte, F ~, Candeago, RM 1. 1Unitd Operativa di Neurologia, Ospedale San Martino di Belluno, Belluno, haly; 2Cattedra di Neurologia, DPMSC, Universitd degli Studi di Udine, Udine, Italy
Post-Malaria Neurological Syndrome (PMNS) is a rare condition following recovery from a usually severe episode of Plasmodium faldparum malaria. It is characterized by acute confusional state or psychosis and non-specific neuropsyckiatric signs, including inap- propriate behaviour, speech disorders, generalized convulsions, visual hallucinations, fine limb tremor and catatorfia. Mefloquine treatment of the preceding malaria episode has been assodated with PMNS. Patients usually don' t develop focal neurological signs and recover spontaneously. Until now, only one case of PMNS has been reported in the Westenr hemisphere.
We describe the case of a 60-year-old Italian man, who developed a severe form of P. falciparunr malaria after being in French Guinea. He was treated with Quinine, Doxycycline and Ceftrimxone. Nine days after recovering, he developed generalized weakness, limb tremors, shivering and dizziness. Subsequently, he became disoriented to time and space, confused and aphasic. Blood examinations showed no parasites. Apart from motor aphasia, he showed no neurological focal signs. He remained confused and aphasic for 3 days. No lesion was demonstrated in brain CT and MRI scans. Lumbar puncture showed an increased protein content (1252 mg/dL), and 10 lymphocytes/ microL, suggesting that PMNS could be considered an acute inflanunatory encephalopathy. To our knowledge, tiffs is the first European case of PMNS. We believe neurologists should consider PMNS in the differential diagnosis of a patient who has recently recovered from P. faldparum malaria and presents with sudden confusional or psychotic states.
0834 HTLVdI: A Cohort of Brazilian Patients
M. Menna-Barreto. Divison of Neurology, PUCRS, Porto Alegre, Brazil
Background: Although the role of HTLV-II in human disease has yet to be clearly defined, there is growing evidence that, like HTLV-I, infection may also be associated with neurological disorders. Methods: We studied a cohort o f 22 HTLV-If-infected individuals using three scores on the Expanded Disability Status Scale (EDSS), with higher scores indicating more severe disability. Statistical analysis was done by Kaplan-Meier method. Results: 22 HTLV-II-infected patients were followed during 94 months: 12 females and 10 males; median age 37.5 years; 50% Caucasians, 22.7?,'0 Afro-Brazilians, 18.2% mulattos and 9.1% Amerindians. At the end of the study, 63.6?,'0 of the patients have reached EDSS score of 3.5, 13.6"/o a score of 6 and 4.5°,5 a score of 8. Time from onset of neurological symptoms to assigmnent of a score of 3.5 in EDSS scale was 49.1 months (195°,5 CI; 32.9 to 65.3), to assigmnent of a score of 6 in EDSS scale was 86.1 months (1957,'o CI; 76.6 to 95.6) and to score of 8 in EDSS scale was 92.6 months (195% CI; 87.8 to 97.2). Urinary symptoms were the first (150%) and the most common complaints (190.9"/o). The neurological exanfination disclosed mainly deep sensory sense disturbances (95.4°,5) and pyramidal sylrdrome (54.5%). Conclusion: This cohort study has demonstrated low and increasing grades of disability among HTLV-If-infected individuals, supporting an association with neurological disease.
0835 Molecular Analysis of Measles Virus Genome Derived From SSPE and Acute Measles Patients in Papua New Guinea
