Impact of Multifidus Muscle Morphometry on the Clinical Evolution of Chronic Low Back Pain

Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm3 ± 39, after physiotherapy it was 203 mm3 ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.

MRI Signal Abnormalities of the Optic Tracts, a Marker of Meningoencephalitis Caused by Trypanosoma Gambiense (TG)—A Delayed Patho-Radlological Correlation

Parasitic meningoencephalitis presents several etiologies which sometimes depend on their geographical location. They require thorough blood and cerebrospinal fluid check-up for directing an efficient treatment. Clinicians and radiologists are constantly looking for specific signs that could point to a particular etiology. The meningoencephalitis caused by Human African Trypanosomiasis (HAT) due to Trypanosoma brucei gambiense (TG) is a rare disease characterized by a slow progression, over years sometimes. Its non-specific presentation either clinically or in imaging can lead to misdiagnosis and thus, delay the treatment. However, involvement of the optic tracts seems to be characteristic of this condition, on old data from animal experimentation and recent high-field MRI data. MRI is the best current technique to explore the brain, cranial nerves, and visual pathways. In this article, we are going to present two observations of meningoencephalitis caused by HAT and then discuss some specific aspects of this neglected and re-emerging disease.

CT Scans and Delays in Diagnosis of Stroke in Senegal’s Regional Hospitals: A Multicenter Study of 655 Cases

Stroke represents the 2nd cause of mortality and 1st cause of physical disability in the adult population. In Senegal, it represents 30% of hospitalization and 2/3 of the mortality in the department of neurology in the capital city, Dakar. Objective: To specify the types of stroke and to evaluate diagnostic delays in Senegal’s regional hospitals. Materials and Methods: This was a retrospective, cross-sectional, descriptive, multicentric study for 4 years (from 2014 to 2017) including any patient presenting a clinical suspicion with a CT scan confirmation of stroke in one of the 9 regional hospitals in Senegal with a recruitment period of 6 months per hospital. CT scans were performed with a 16 slices machine in 6 hospitals, 4 slices in 2 hospitals and 2 slices in 1 hospital. We studied the types and location of strokes, the associated signs and the time from stroke onset to admission and the time from admission to CT scan. Results: 655 patients were retained including 322 men and 333 women for an M/F ratio of 0.96. The average age was 63 years (range: 7 years, 112 years). High blood pressure was noted in 59.2% of patients and diabetes in 10.7% of patients. Strokes were ischemic in 76% of cases involving the middle cerebral artery in 73% of cases and hemorrhagic in 24%, of which 80.7% were deep localized. A mass effect was noted in 7.5% of cases, an engagement in 6.9% of cases and ventricular hemorrhage in 2.7% of cases. The delay between the onset of the deficit and admission was less than 6 hours in 10.6% of patients. The time between the onset of stroke and admission to hospital was specified in 416 patients (63.5%) of the study population, it was less than 6 hours in 10.6% of patients, between 6 hours and 24 hours for 29.3% and more than 24 hours for 60.1%. Between admission and the CT scan, the time was precise in 459 patients (70%), it was less than 6 hours in 37.9%, between 6 hours and 24 hours in 43.6 % and more than 24 hours in 18.5%. Conclusion: CT is central to the diagnosis of stroke in rural areas. However, there is a significant delay in diagnosis and management.

High-Field MRI Contribution in Tolosa-Hunt Syndrome (THS). Report of Two Cases and Review of Literature

Background: Tolosa Hunt Syndrome is an inflammatory condition of unknown etiology of the cavernous sinus and superior orbital fissure. Because of the difficulty in establishing histological evidence, his diagnosis is based on a set of arguments established by the International Headache Society. MRI allows indirect visualization of the granuloma and plays a key role in diagnosis and follow-up. Aim: To illustrate High-field MRI contribution in Tolosa-Hunt Syndrome (THS). Cases Presentation: Two patients, a 25-year-old female and a 40-year-old male were recruited in this retrospective case report study at the Radiology service of Fann University Hospital (Dakar Senegal). The first patient has been suffering from a right retro-orbital pain and diplopia for 2 months and the second from a painful oculomotor nerve palsy for 3 months. Blood tests, lumbar puncture, thyroid hormone levels and an infectious screen were done. Screening for converting enzymes, and serum antibodies were also done. They underwent a high field MRI (Siemens 1.5T) with T1, T2, FLAIR, T2*, diffusion B1000, TOF polygon, CISS 3D and T1 gadolinium sequences in the 3 planes space. No significant abnormality was detected in blood tests or CSF analysis. Screening for converting enzymes and serum antibodies screen were also negative. For each patient, MRI examinations showed a non tumoral thickening of the right cavernous sinus, suggesting a granulomatous involvement. Tolosa Hunt Syndrome was evoked firstly. They were put on corticotherapy at high doses with a spectacular regression of symptoms. The Criteria of the International Headache Society of THS were met in both patients. Conclusion: High-field MRI is a significant diagnostic tool in the assessment of painful ophthalmoplegia. It allows a direct visualization of the granuloma of the cavernous sinus and assesses its course throughout the disease.

High Field MRI in Human African Trypanosomiasis (HAT)

Human African Trypanosomiasis (HAT) or sleeping thickness is a forest and rural disease;where agriculture is the main activity. It is a chronic and lethal disease without treatment. HAT is caused by two parasites;Trypanosoma Brucei Gambiense (gTB) and Trypanosoma Brucei Rhodesiense (rTB) transmitted to humans by the tsetse fly. It is endemic condition in Africa between the 15&deg north latitude and the 20° south latitude. It is reported outside this area in travelers who stayed in endemic zone. Infection by gTB is wider and more frequent (98%) than that by rTB (2%). The Democratic Republic of Congo is the most affected country with more than 75% of reported cases. The geographical distribution is not homogeneous. There are more affected regions in a zone called “foci” which represents areas favorable to the development of the vector. Its diagnosis and treatment are very important because of its social and economic impact at both the individual and community levels. Promising molecules including fexinidazole are currently undergoing testing. Nowadays populations move more and more easily but the discovery of this disease in daily neuroradiological practice is exceptional. We propose in this paper through two observations, reminders on epidemiological, clinical and MRI features of HAT. It typically performs the edematous, bilateral and diffuse encephalitis. It is important to distinguish these aspects from the arsenic-induced encephalitis that may occur during treatment. Only vector control allows eradicating this disease. WHO has set targets elimination of HAT as a public health problem for 2020 deadline.

Assessment of a Database Management System in a Mammogram Unit of a Radiologic Department in Fann Teaching Hospital (Senegal)

Objectives: To evaluate a medical data management system of a mammogram unit in a department of Radiology. Methods: This is a qualitative and quantitative assessment study in Fann Teaching Hospital between April 2014 and June 2015 one year after its implementation. The quantitative component consisted of the audit of the database to determine the socio-demographic characteristics of patients and the results of mammograms. The qualitative component assessed users’ experience. For analysis, quantitative data were extracted and transferred to Microsoft Excel. For scale variables, we calculated the averages and extremes. For qualitative variables, we established percentages. Results: During the study period, 433 patients underwent mammograms. The average age of patients was 48 years. The completion rate maintained above 85% was below 26% in the first two months of use. As to the completeness given examinations, it was still above 83%. The results of mammogram examinations were normal in the majority of cases: 96% for the right breast and 95.2% for the left breast. All users had a favourable opinion about the database. The reasons were better work organization, comprehensiveness, accessibility and standardization of information about the patient and especially the immediate availability of statistics. For 60% of these health professionals, complaints related to the use of the software were the time-consuming of filling data. Conclusion: This study mainly describes the perception of health professionals on the computerization of radiological examinations. It offers some advantages, proposes improvements and opens avenues for reflection on the globalization of the computerization of patient records in Radiology.