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ABSTRACT: Cryptococcal infection is the most common fungal infection of the central nervous system. More than 50% of the cases of cryptococcal infection are superimposed on an immunosuppressive or other general debilitating condition. Cerebral cryptococcosis usually presents as meningitis or meningoencephalitis, although cerebral granuloma has also been reported. Hydrocephalus is the most common neurosurgical complication of cerebral cryptococcosis. The majority of patients require only medical treatment with antifungal drugs. However, when complications ensue, surgical intervention is mandatory. We suggest that chronic meningitis be ruled out in all patients prior to the placement of shunts. In the two cases reported here treatment of cryptococcal meningitis was a combination of amphotericin B and flucytosine for six weeks. Fluconazole is a new alternative and at least as effective as amphotericin B.
Revue Neurologique 02/1993; 149(5):326-30. · 0.49 Impact Factor
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ABSTRACT: Postpartum hypopituitarism or Sheehan's syndrome is frequent in Sahelian Africa. From February 1983 to July 1988, the authors observed 40 cases at National hospital of Niamey (Republic of Niger). These patients were Black African women living in rural areas, without medical assistance during the last delivery. Two signs were required for the diagnosis: absence of postpartum lactation and prolonged amenorrhoea. A 15 points score was used for identification of each case. Postpartum hypopituitarism is a severe disease in Sahelian Africa: after the pituitary necrosis, 80% children died. 60% of patients had no living child or only one malnourished infant with a poor prognosis. The social future of these sterile African women seemed uncertain. Hormonal treatment (estrogens, thyroxin, cortisone) is justified but expensive. Exceptionally a pregnancy developed after Sheehan's syndrome under treatment with childbirth of a living infant.
Bulletin de la Société de pathologie exotique 02/1991; 84(5 Pt 5):686-92.
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La Presse Médicale 04/1986; 15(9):439. · 0.67 Impact Factor
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ABSTRACT: From February 1983 to December 1985, the authors investigated 19 african women with Sheehan's syndrome in Niamey (Republic of Niger). A 15 points diagnostic score was systematically used. Two signs were indispensable for the diagnosis: post-partum agalactia (or severe hypogalactia) and amenorrhea. At least 9 points score was found for every case. Eighteen patients lived along a major road in Niamey and in Dosso departments. The prevalence of this disease is probably important but many cases were not diagnosed since there was no medical examination. Sheehan's syndrome was predominantly diagnosed among Fulani women. Young women (mean age: 26 years) in intensive sexual life, primiparous (8/9) or multiparous (11/19) were concerned. Emergence circumstances of signs were: childbirth at home (18/19), severe vaginal bleeding at placental birth (14/19), rare transfusions (2/19). The infant of a mother with Sheehan's syndrome had a poor prognosis: 9 deaths among 11 deliveries for multiparous, 7/8 for monoparous. The infants were stillborn or more often dead during the first months. Deaths were in relation to absence of maternal lactation. For the primiparous, then infertile women because of hypopituitarism, the repudiation becomes often the only social way of life. Lasting hormonotherapy was not available because 18/19 patients were very poor. Prevention is not possible before long, especially in primiparous, because of: the mentality: the first delivery at home with the mother is the traditional habit; the importance of the required measures.
Médecine tropicale: revue du Corps de santé colonial 47(1):17-22.
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La Revue de Médecine Interne 8(5):533-4. · 0.61 Impact Factor
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ABSTRACT: The Tolosa-Hunt syndrome is a painful ophthalmoplegia in relation with a granulomatous lesion of the cavernous sinus of obscure etiology. The authors report 4 cases diagnosed at National Hospital of Niamey (Republic of Niger). They were 3 men and one woman. The unilateral retro-orbital cephalalgia was constant. Three patients had left oculomotor and abducens nerves' palsies and one only left trochlear nerve's palsy. In three cases the therapeutic efficacy of systemic corticosteroids was dramatic with complete remission of clinical signs. In a fourth case, chlorambucil was used with complete recovery.
Médecine tropicale: revue du Corps de santé colonial 51(2):173-6.
