The Management of Lumbosciatic Disc Related Disease at Renaissance University Teaching Hospital of N’Djamena-Chad: About 156 Cases

Introduction: Low back disc disease (LSD) is a neurosurgical condition with significant socioeconomic repercussions. The objective of this study was to determine the frequency and report the modalities of management. Methodology: This study on lumbosciatic disc disease was carried out in the neurosurgery department of the University Hospital Center (CHU), la Renaissance in N’Djamena. It covered a period of 12 months (from September 2019 to August 2020). A descriptive and an analytical approach were used. The variables studied were epidemiology, clinic, radiology and therapy. Results: the results showed that LSD represented 14.7% of the reasons for consultation in neurosurgery. The average age was 45.8, and to some extent, it ranges between 18 and 76. Lifting was the main reason behind lumbosciatic disc disease with 35.9% of cases, followed by a sedentary life style which represents 30.8%. Lumbosciatica L5 was noted in 49.4%. Obesity and overweight were significant risk factors (P = 0.02) reported in 59% of cases. Motor and sensory deficits were observed in 14.8% and 17.3% of cases, respectively. CT of the lumbar spine was performed in 91% and MRI in 28.9%. The L4-L5 disc herniation represented 74.3% of cases, with a lateral location in 44.2% and L5 radicular impingement in 30.8%. Conservative treatment was instituted in 87.2% and surgical treatment in 12.8% of cases. Conclusion: LSD is caused by a sedentary lifestyle, physical work and overweight. Surgery deals with complicated cases and cases not responding to conservative treatment.

A Rare Cause of Hemiparesis: Intracranial Mycotic Aneurysm—A Case Report, and Review of the Literature

Background: The intracranial mycotic aneurysm is known to be a rare complication of infective endocarditis and it is more clinically challenging to get this diagnosis right when it happened to be in a patient without a past medical history of heart diseases. We report a documented case of mycotic aneurysm revealed by isolated left hemiparesis and our management with the collaboration of the cardiology department. Case Description: A 48-year-old male patient with a history of teeth loss, a chronic smoker presented with sudden heaviness in the left upper and lower limbs. No fever. Physical examination revealed a left hemiparesis of 3/5 on the muscle tone scale without the stiffness of the neck. The CT-Scan and the MRI conclude of subarachnoid and cerebral hemorrhage with right temporal hematoma being most probably a vascular malformation. The cerebral arteriography concluded of a right Sylvian mycotic distal aneurysm in the M4 segment. Transesophageal echocardiography was performed and concluded of infectious endocarditis with mitral and aortic valvular disease grade II. Positive blood culture for staphylococcus coagulase-negative. The patient was managed with antibiotic therapy and clinically stable after 28 days. He was then transferred to the cardiology department for follow-up. Six (6) months later a CT-angiography was done for a check-up and shows no further changes in the aneurysm. The patient underwent surgery, two (2) months later, for clipping the aneurysm because the aneurysm did not regress in size. The aneurysm was then excluded with an eventless post-operative period, confirmed by controlled cerebral arteriography. The patient was discharged five (5) days later and he is doing well. Conclusion: Mycotic aneurysm is a rare consequence of infective endocarditis. The distal sites of the middle cerebral artery are commonly found, and conservative treatment with a long course of antibiotics like amoxicillin 12 g/24h for 6 weeks or direct surgical clipping or excision can manage it.

Unilateral Frontal Sinus Aspergillosis: A Case Report and Review Literature

Frontal sinus aspergillosis is a rare infection that can be usually associated with immunocompromised states and life-threatening with high mortality rate. The authors report in a developing country a case of immunocompetent patient with left unilateral frontal headache, associated with left eye ptosis. The Brain CT Scan revealed frontal sinus aspergillosis. She underwent surgery followed by itraconazole cure. The outcome is successful after a period of 14 months with resolution of symptomatology. Anatomopathological examination confirmed aspergillosis. They share their experience of management of this disease in a country where neurosurgery is very young specialty and where molecules against aspergillosis are not available.