BackgroundHolmes tremor is a rare symptomatic movement disorder. Currently suggested pathophysiological mechanisms of the disease are mostly derived from stroke cases. Although rare, cerebral toxoplasmosis may strengthen the pathophysiologic mechanism of disease.Case presentationA case of Holmes tremor secondary to cerebral toxoplasmosis in an AIDS patient is presented. A relevant literature search was performed, using pubmed and several entries for Holmes tremor as labelled in the literature. The unifying feature of our case and those of the literature is the involvement of either the cerebello-thalamo-cortical and/or the dentato-rubro-olivary pathways. The abscess or the extension of surrounding edema beyond these two circuits may account for the superimposed dysfunction of the nigrostriatal system in some but not all cases. The short delay observed in our observation and the dramatic response to treatment may indirectly support the secondary neuronal degeneration theory in the mechanism of Holmes tremor.ConclusionCases of cerebral toxoplasmosis in AIDS patients also provide arguments for the role of the thalamo-cortical and/or the dentato-rubro-olivary pathways dysfunction in the pathogenesis of Holmes tremor. Involvement of the nigro-striatal pathway may not be crucial in the development of this syndrome. Our case also brings additional indirect arguments for the role of secondary neuronal degeneration in the mechanism of Holmes tremor.

Background: Cardiovascular emergencies have become a public health problem with a high burden in low-income settings. This is due to the high rates of cardiovascular risk factors that are fast reaching epidemic proportions. There is paucity of data on cardiovascular emergencies to guide repost strategies in our setting. Our aim was to determine the clinical presentation and outcome of cardiovascular emergencies at Yaounde Emergency Center. Methods: We carried out this cross-sectional study between June 2015 and May 2017. We included all patients with confirmed cardiovascular emergency. We consecutively collected data on socio-demography, symptoms on admission, past history, clinical findings, and final diagnosis at discharge or in the event of death. Results: Of the 8285 patients admitted for medical emergencies, 388 (4.7%) were cardiovascular emergencies. Their mean age was 59.5 ± 13.8 years, and 59% were males. The Medical Emergency Aid Service was the means of transporting 4% of patients. The median time of arrival at the hospital was 48 hours. Symptoms on admission were mainly weakness of a limb (43.8%), and altered consciousness (33.5%). The most common cardiovascular emergencies were ischemic stroke (30.9%), hypertensive emergency (21.4%), and hemorrhagic stroke (16.5%). The most common comorbidity was diabetes (21.9%). The death rate in the 24 -72 hours was 14.4%. The causes of death were hypertensive emergency (35.7%), and hemorrhagic stroke (30.3%). Conclusion: Stroke and hypertensive emergency were the most frequent cardiovascular emergencies. The early mortality was high. Hemorrhagic stroke and hypertensive emergencies accounted for most cases of death.How to cite this paper:

No abstract