Acute disseminated encephalomyelitis (ADEM) is a monophasic, multifocal, demyelinating, autoimmune disease that affects the central nervous system (CNS). It usually occurs after a systemic infection, usually viral, including certain coronavirus infections. A 27-year-old girl presented with complaints of left interscapular pain, paresthesias and weakness in the ipsilateral upper limb. These symptoms followed paresthesias on the fingertips of her right hand the day before her admission. she was treated two weeks earlier for pneumonia with COVID-19. Her clinical pattern resulted in a moderate weakness of the left limbs associated with tactil and algic hypoesthesia in the lower left limb ascending until the C4 level in the left side. Magnetic resonance imaging (MRI) of the brain and spinal cord showed diffuse spontaneous hypersignals on fluid-attenuated inversion recovery (FLAIR) images at the cerebral level and on T2-weighted images at the spinal level. These imaging lesions coupled with the medical history of a recent COVID-19 infection led to the diagnosis of acute disseminated encephalomyelitis (ADEM) post covid-19. The clinical condition improved rapidly with intravenous (IV) corticosteroid therapy and IV immunoglobulin combined with physiotherapy. ADEM is a demyelinating autoimmune disease which is increasingly reported during this current corona virus pandemic.
One third of ischemic strokes have no known cause, and basic understanding of the mechanisms of these "cryptogenic" strokes is lacking. However, observational studies are increasingly bringing to light an etiology that has long remained hidden, the carotid web. The authors report a case of carotid web in a 32-year-old patient, gardener, from sub-Sharan Africa, with no medical history or known cerebrovascular risk factors. Indeed, due to a sudden weakness of his left limbs, the MRI was performed and revealed an ischemic stroke positive on diffusion-weighted within the territory of the right middle cerebral artery. FLAIR sequences were normal, while T 2 * sequences revealed an M1 thrombus ipsilateral to the brain lesion. After thrombolysis and thrombectomy, the patient's weakness improved significantly. Digital subtraction angiography of supra-aortic trunks revealed the carotid web, which was incriminated as the etiology of this ischemic stroke in the absence of any abnormality on the other ancillary examinations that were performed. To prevent a recurrence, the patient was given Aspegic 250 mg/day and received physical therapy. The clinical course was improved and at 3 months, there was no new cerebrovascular event and his Rankin score was 1.
Although it is a vaccine-preventable disease, tetanus is frequently found in sub-Saharan Africa. Because of its rarity, this disease poses two problems for doctors of the 21st century: to make early diagnosis in order to refer patients to appropriate care structures, and to continue to ensure correct prevention of an affection that few current doctors have met. In it generalized form, the diagnosis of tetanus is easy, but when the beginning is localized, tetanus can be change with other diseases leading to a diagnostic wandering and a delay of adequate management. We report a case of tetanus in an 18-year-old male, who was received for neck pain and stiffness of the neck with a positive Kernig sign associated to fever since 48 hours. Initially treated for meningitis, the patient will develop at day 3 of hospitalization, the signs of generalized tetanus which led to evoked the diagnosis of tetanus. This diagnosis was reinforced by the notion of a rusty nail injury to the soles of the right foot 3 weeks before hospitalization and the absence of anti-tetanus vaccination. After using tetanus serum and vaccination with antibiotics (Metronidazole and Penicillin) and Diazepam in association with stripping of the wound under the foot, the patient was improved. This case illustrates that any neurological sign with the first trismus must evoke until proof of the contrary, a tetanus especially in case of association with a wound even if the immunization schedule is up to date.
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