Troubles neurologiques

Tuberculous meningitis (TBM) is a severe infectious disease in the Central Nervous System (CNS). It’s elusive to differentially diagnose TBM with Bacterial Meningitis (BM). Traditional diagnosis of TBM is based on clinical features, etiological examination, and the biochemistry analysis of cerebrospinal fluid. These conventional methods are time consuming and insensitive, which could lead to a delay in TBM diagnosis. The aim of our study is to develop a diagnosis model which could distinguish TBM from BM rapidly and accurately. A retrospective review of all 191 CNS patients was conducted to determine the differences between TBM (n=145) and BM (n=46) based on clinical and laboratory tests. Logistic regression was used to identify the parameters independently predicting TBM and to develop a diagnosis model. A receiver operator characteristic curve was used to determine the best cutoff for the diagnostic model. Seven parameters were found predictive: Coma, ESR30, FIB, Monocytes%, Lymphocytes%, Neutrophils%, and EOS%. Application of the above seven parameters revealed 89.0% sensitivity and 93.5% specificity. This diagnostic model can help improve the accuracy of the early diagnosis of TBM.

Background: Spinal myoclonus is a rare movement disorder characterized by myoclonic involvement of a group of muscles supplied by a few contiguous segments of the spinal cord.

Case presentation: We present here a case of 35 year old male with spastic paraparesis for two months associated with involuntary spontaneous abdominal contractions, accompanied by involuntary jerks of his legs. MRI findings pointed C3-C4 of disc herniation. He was treated with infusion dose of diazepam (0.1 mg/kg) and levetiracetam 500 mg twice daily with marked improvement of the jerky movement.

Conclusion: It is rare spinal myoclonus due to cervical disc herniation. We reported a male with C3-C4 of disc herniation as the origin of the myoclonus.

The aim of this study was to assess epilepsy treatment outcome, adherence to Anti-seizure medication (ASM), and its predictors among epileptic patients on follow-up at the chronic care unit of Jimma University Medical Center with a total of 168 epileptic patients enrolled in the study. Data was collected by data collectors using data abstraction formats, then entered and analyzed using SPSS version 26.0. Multiple logistic regression analysis was performed to identify the association between dependent and independent variable. In this study, 132(78.6%) patients were adherent to their ASMs. Seizure recurrence was identified in 120(71.4%) patients. Rural residence (AOR=6.42, 95% CI: 1.32, 31.28, P=0.02), chronic ASM therapy for above five years (AOR=20.86, 95% CI: 2.66, 163.77, P=0.00), and complaint of ASM-associated undesirable effect (AOR=13.51, 95% CI: 2.72, 67.26, P=0.00) significantly increased the probability of seizure recurrence. On the other hand, the presence of seizure triggering factors (AOR=0.12, 95% CI: 0.02, 0.64, P=0.01) decreased the probability of seizure recurrence by 88%.

Background: Hyperammonemic encephalopathy is a rare cause of altered level of consciousness in patients. When investigating encephalopathy, common causes are ischaemic, metabolic, toxic, inflammation, demyelinating, degenerative, and hereditary and infection. In this case reports, we present a rare case of encephalopathy in a patient with hyperammonaemia on a background of multiple myeloma.

Case presentation: A 67 year old Caucasian male with a background history of monoclonal gammopathy of undetermined significance, presented with confusion, asterixis and recurrent falls. As part of the work up he was found to have a high ammonia level at 123 umol/L (normal 0-50 umol/L). The patient also had a bone biopsy as he had mild pancytopenia and hyperproteinemia and was diagnosed with multiple myeloma, likely a progression from his paraproteinemia disorder. The patient significantly improved to his baseline with normalisation of ammonia level once he was commenced with Velcade based chemotherapy as well an adjunctive treatment with lactulose.

Conclusion: Hyperammonemia in multiple myeloma is a rare but an important differential in patients with encephalopathy. The diagnosis of this is important so that an appropriate treatment can be provided.

Background: As the population ages and more people are affected by multiple chronic conditions, the prevalence of Peripheral Neuropathy (PN) has also rapidly increased. This swift rise in PN leaves clinicians and patients challenged by a lack of consistent diagnosis and treatment guidelines.

Purpose: To assist those affected by PN, it is imperative to understand the breadth of symptoms, experiences, and factors related to the quality of life. The primary aims of this study are to (1) characterize the symptoms of PN in a nationwide sample; (2) discern differences in symptom clusters, given perceived causes of PN; and (3) identify significant physiological symptoms related to the quality of life for people with PN.

Methods: An online survey of people in online PN support groups. Participants were recruited primarily via an open request sent to recipients of web-based communications from nationally recognized online PN support groups. Inclusion criteria were as follows: Self-reported diagnosis of PN, ability to read English or Spanish, residence in the U.S., and age ≥ 18 years.

Results: A total of 608 individuals with PN were included in the analysis. This sample represents 49 U.S. states and the District of Colombia; 221 were male and 387 female. Their disease severity and etiology were similar to previously reported information on this population, with 53.3% of respondents suffering from PN without a known cause. Among known causes, diabetes was the most common (19.6%), followed by chemotherapy (6.9%) and autoimmune diseases (3.6%). Factors affecting the quality of life among people with PN included lower extremity mobility, upper extremity mobility, sleep disturbance, depressive symptoms, and patient activation.