Ischaemic Stroke Complicating Infective Endocarditis: Microbleeds Are the Diagnostic Clue

Introduction: Ischemic strokes represent a classic complication of infective endocarditis (IE) and are most often related to the fragmentation of valvular vegetation. In most cases, they occur in the Sylvian territory and are related to Staphylococcus aureus. MRI can demonstrate, in addition to the AVCI image, cerebral microbleeds (CMBs) that are very suggestive of the diagnosis. We present the case of a patient who presented an ischemic stroke occurring in the context of infective endocarditis. Observation: A 32-year-old woman with no previous medical history initially presented with acute febrile headache, two weeks later she developed right hemiplegia with aphasia in the context of fever. Her general examination revealed lesions on the soles of her feet, in the form of nodules, infected in places, suggestive of Janeway nodules (characteristic of IE). The brain MRI showed an ischemic stroke in the Sylvian territory, with the presence of multiple microbleeds on the magnetic susceptibility sequences. The biological examination showed a severe inflammatory syndrome;the transthoracic echocardiography (TTE) confirmed the presence of vegetation on the aortic valve;and the blood cultures showed a Staphylococcus aureus. Antibiotic therapy was started, and the patient was transferred to the cardiology department. Discussion: Our observation has a double interest. The first is clinical due to the presence of plantar nodules (Janeway’s nodules) that are characteristic of IE which should orientate the diagnosis before the installation of the stroke, and the second is radiological and linked to the discovery of microbleeds. Their presence is increasingly reported in the literature, but their pathophysiology is not yet very clear. Conclusion: Stroke is the most frequent extracardiac complication during IE. The presence of microbleeds contributes to early diagnosis, especially in asymptomatic forms.

Limbic Encephalitis as the First Manifestation of Neurosyphilis: A Diagnostic Challenge

Limbic encephalitis (LE) is a clinical entity related to a mesial temporal lesion resulting in a combination of anterograde memory dysfunction, behavioral changes, and seizures. The most common causes of limbic encephalitis are Herpes Simplex Virus (HSV) encephalitis, autoimmune encephalitis. Neurosyphilis is an exceptional aetiology. The early diagnosis and management of the disease determine the prognosis. This clinical course highlights the diagnostic challenge limbic encephalitis can cause and the importance of considering neurosyphilis in patients with specific or unspecific neurological symptoms. We report a case of a mesiotemporal form of neurosyphilis revealed by a LE.

The Trail Making Test in Morocco: Normative Data Stratified by Age and Level of Education

The purpose of this study is to design a Moroccan Trail Making Test B;explore the effects of age, education and gender on the performance of the Trail Making Test (TMT);and provide normative information in Moroccan subjects. Our normalization study was conducted on 348 subjects (156 female and 192 male). The subjects were classified into four groups based on age (18 - 39 years, 40 - 59 years, 60 - 69 years and ≥70 years), and three groups based on educational level (3 - 6 years, 7 - 10 years and ≥11 years). The data were analyzed using descriptive statistics through SPSS. The results displayed that increasing age and decreasing levels of education significantly result in a decreased performance on the Trail A, Moroccan Trail B and English Trail B. Only 229 bilingual subjects among the 348 initial subjects completed both versions of Trail B. There was no significant difference on performance between Moroccan Trail B and English Trail B for these subjects.

Moroccan Version of the Mattis Dementia Rating Scale: The Effects of Age, Education, and Gender

The present study aims to adapt and to standardize the MDRS in the Moroccan population. The Moroccan Dementia Rating Scale was adapted in Arabic and was administered to 192 younger and older individuals without cognitive deficits (96 men and 96 women) whose ages ranged from 18 to 85 years old. To investigate the impact of age and schooling, participants were classified into three levels of education, and three age categories. The results show that age and level of education strongly influenced the performance of an average of 124/144 of the MDRS subjects who were tested.

Population Normative Data of the Moroccan Arabic Version of Three Components of the 10/66 Dementia Research Group Cognitive Test Battery;with Moroccan Illiterate and Semi-Illiterate Subjects

The aim of this study was to provide normative data of the Moroccan Arabic version of the 10/66 Dementia Research Group cognitive test battery and to explore the effects of age, education/illiteracy, and gender on the performance of these tests. One hundred healthy subjects (67 illiterates and 33 semi-illiterates) participated in this study. None of the participants had serious medical, psychiatric, or neurological disorders including dementia. The protocol included the administration of three components of the 10/66 Dementia Research Group cognitive test battery;Community Screening Instrument for Dementia (CSI “D”, generating the COGSCORE measure of global function), and the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) verbal fluency (VF), word list memory (WLM, immediate recall) tests. All the test scores were not significantly influenced by sex and age. There was no significant effect of education/illiteracy on the CERAD verbal fluency (VF) and Word List Memory (immediate recall) test scores, but a weakly significant (p < 0.05) effect on the CSI “D” COGSCORE performance. These normative data will be useful for clinical interpretations of the three components of the 10/66 Dementia Research Program protocol in illiterate and semi-illiterate Moroccan subjects with cognitive disorders.

Mild Cognitive Impairment in Parkinson Disease: A Neuropsychological Study of 25 Patients

Parkinson’s disease (PD) is associated with an increased incidence of cognitive impairment and dementia. Population-based cohort of 25 patients with incident PD underwent a large neuropsychological battery. Executive functions were the most affected cognitive domain including particularly initiation, mental flexibility and inhibition. Episodic memory and visuo-spatial functions were less affected. We found that 92% of patients were classified as having Mild Cognitive Impairment (MCI);most of them experienced PD-MCI Single-Domain (17 patients) with disturbances on executive functions. Less frequently, we identified a group of patients with multiple-domain PD-MCI demonstrating deficits on executive functions as well as on episodic memory and/or visuospatial capacities.