Biomedical subjects
Publications and source records attributed to M C Ba.
Spinal cord compressions are mainly due to Pott disease. We present a rare case. A 31 years old woman presenting a spinal cord compression due to an aspergilloma. Our patient presented also a pulmonary aspergillosis. The spinal compression was due to a contiguous extension of aspergillus to the epidural site. The treatment associated surgery and medical treatment (Ketoconazole), with efficient results.
From 1975 to 1995, 335 patients were operated for hydrocephalus in neurosurgical clinic of CHU Fann, and got ventriculo-peritoneal shunt. 3 cases of patients presenting an uncommon complication of ventriculo-peritoneal shunt: abdominal pseudo cyst, are reported and discussed. The digestive symptoms are the first to manifest themselves for a period of time, then confusing with other forms of abdominal cysts. The suggested treatment is to remove the shunt from the peritoneal cavity and perform a ventriculo-atrial shunt, then to proceed to a laparotomy, drain the fluid and resect the cyst wall. The results are excellent.
In this paper, one case of syndrome of caudal suppression associated with a syndrome of Klippel Feil is discussed. It concerned a 14 years old boy, born form a diabetic mother with congenital abnormalities such as: urinary incontinence, facial dysmorphia, a short neck, an arachnodactylia, a lumbar kyphosis, a permanent flexion of the knee, a kalipe cavus, the spine, a partial agenesis of the third and fourth lumbar vertebrae a total agenesis of the fifth and sacrum; This syndrome is infrequent and the pathophysiological mechanisms are still under discussion and no therapeutic strategy is proposed. This case offers an opportunity to the authors to make review of the medical literature on this subject. They emphasized on the interest to look for a vertebro-medullary malformation every time a child comes to us with walking problem or enuresia, this fact should be enforced when mother is diabetic.
From 1969 to 1988, 211 cases of spina bifida were collected from the Neurosurgical Clinic at the University Teaching Hospital of Dakar. Cases were reviewed for genetic and environmental factors. There were 103 males (48.81%) and 108 females (51.19%). The most important ethnic group involved were toucouleurs (20.11%). Consanguineous marriages in parents of affected infants were lower than in the general population (62.5% vs 71%). Recurrence has been noted in 4.26% of the cases. There were more fifth-born children affected than expected (16.2% vs 9% p < 0.02). A seasonal and geographic variation of the incidence has also been observed. Infants conceived between November and February appear to be of highest risk (36.16%). The incidence is higher in the north-west and lower in the south-east part of the country. Lower social-economic classes were the most involved. The authors support the hypothesis of multifactorial etiology in Spina Bifida.
Because of frequency and seriousness of myelo radicular complications of narrow lumbar canal, the authors studied its radiological and anatomical measurements in order to specify the standards for senegalese negro african. For that purpose, they collected samples of 21 lumbosacral spines from new cadavers through medico legal necropsies. Pieces have been first X rayed, then treated. They measured the antero posterior diameter of vertebral corpse, the anterio posterior diameter of vertebral canal, the narrowest transversal diameter of vertebral corpse and the inter pedicular distance. The authors found no significant differences between radiological and anatomical measurements, but the latest changed from one stage to another. The variations also were not important comparatively to standards established by two authors.
From 1980 to 1990, 64 cases of Lumbar canal Stenosis have been recorded and operated on at the neurosurgical clinic. The male sex is prevailing and the breakdown by age groups showed a preponderance of the age sections between 31 and 45 and 46 and 60 years. The sciatic pain was the most frequent starting symptom. As far as the physical signs are concerned, the areflexy of the tendon predominates. The saccoradiculography has established the diagnosis in most of the cases. The laminectomy associated with another technique has permitted to obtain the best result of the treatment. With the advent of the T scan, a better estimation of the lumbar canal will be possible, so as to replace the laminectomy by a more adaptable technique: the remeasurement of the lumbar canal.
From january 1975 to december 1988, 234 hydrocephalus cases of newborn and infant treated by ventriculo-peritoneal or ventriculo atrial shunt have been studied at Dakar CHU (University Teaching Hospital) neuro-surgery clinic. The non infectious complications of this type of surgical treatment using inert material, have been observed in 52 patients or 22 per cent even though infectious complications can be noted in 34 per cent of the cases. Among these non infectious complications the extra-cranial mechanical are the most frequent. Fistula or subcutaneous collection of CSF (13 cases), cutaneous necrosis (12 cases), shunt material disconnection (9 cases), obstruction (8 cases). Chronic subdural hematoma has been proved rare and cranio-stenosis secondary to drainage, exceptional. The treatment of mechanical complications by simple revision emphasizes the maintenance of shunt material in place contrary to the treatment of infectious complications that occurs almost always the removal of a material already expensive associated with a long standing antibiotic chemotherapy. Successive revisions and reinsertion of material can raise technical difficulties which will lead to delayed infection. Careful technical procedure of shunting constitutes the best mean prevention against these non infectious complications.
The authors report five cases of mycetomas with an original localization, cranio-encephalic and vertebro medullary. Four times it concerned a dorsal or cervical mycetoma with deep enlargement responsible for compression of the spinal cord. In the 5th case, scalp infection reached the dura mater. All patients have got histopathological diagnosis. Therapeutic difficulties are evocated about these singular localizations in a pathology for which greater amputation stands as the rule.
Fourteen cases of spinal meningiomas were reviewed. There were 5 males and 9 females, with an average age of 40 years who underwent surgical treatment at the Neurosurgical Division of Dakar University Teaching Hospital. The thoracic spine was involved in 10 cases. The location of the tumor in the spinal canal was epidural in 6 cases and subdural in 8 cases. 7 patients (50%) had marked improvement or stabilization: 4 patients died and in 3 cases, a recurrence was noted. The authors emphasize diagnostic difficulties encountered in the epidural forms.
The authors report 80 cases of collected cranio-encephalic suppurations observed in the Neuro Surgical Unit of the University Teaching Hospital of Dakar from 1969 til 1990. 13 cases were necropsy discoveries and 67 cas that were operated consisted of 55 abscesses of the brain and 25 extra-cerebral empyemas. 56 patients were under 20 years of age with an obvious prevalence of male patients. The collected cranio-encephalic suppuration complicated head trauma in 22 cases and was consecutive to an otorhinolaryngeal infection in 10 cases. The typical clinical aspect of progressive installation associated an intracranial hypertension, motor deficit of one side of the body and an epileptic crisis. A brutal beginning was not an exception in 16 cases. This is often in subdural empyemas. Concerning neuroradiology, cerebral angiography still constitutes our method of choice of investigation; echography can only be performed in infants with permeable fontanela, or during post operative surveillance, using the lacuna created by the craniotomy as an acoustic window. Simple puncture and drainage of the cerebral abscess of the classical cutting away in bloc and the utilisation of echography have considerably contributed for the amelioration of post-operative results.
Epidemiological and clinical analysis of a population of 118 cases o adult subdural hematoma in Sénégal led the authors to make some statements. The age histogram has shown a peak after 50 years old; this fact supports the belonging of subdural hematoma to brain aging pathology. Male were more involved than female (101/17). The head trauma is found in 55%, alcoholism in 3.4%, anticoagulating treatment in 1.69%; others etiological factors were discussed. The authors stressed out the swinging of the clinical picture of subdural hematoma which might lead to misdiagnosis; CT scan or cerebral angiography are useful to make the diagnosis. The pathology of subdural hematoma has given rise to a controversial issue. Surgical decompression allowed to get a complete recovery in 64%. The post operated death-rate was 18.75%.