Stroke Associated with Covid-19 at the YaoundéGeneral Hospital, Cameroon: Series of 10 Cases

Background: The Covid-19 pandemic, which is an infection due to the SARS Cov-2 virus, mainly causes severe damage to the respiratory system, but several studies have reported neurological damage with different manifestations including headaches, seizures, encephalopathies, and stroke. We report a series of 10 patients infected with Covid-19 who had an ischemic stroke at the Yaoundé General Hospital, Cameroon. Patients and Methods: We carried out a prospective study for 12 months between April 2020 and March 2021 by collecting data from patients admitted for Covid-19 at the Yaoundé general hospital. Were included all patients with a diagnosis of stroke confirmed by brain imaging (CT/MRI) following a focal neurological deficit of sudden onset and whose test (nasopharyngeal swab confirmed by PCR) for Covid-19 was positive. Patients diagnosed with a stroke more than 2 weeks (14 days) after the positive Covid-19 PCR test were excluded. Results: The prevalence of ischemic stroke in this hospital-based series was 1.46%. These were six men and four women. The mean NIHSS score was 13.57. The average age of our patients was 58 years. Brain imaging was performed in each patient revealing hypodense lesion in a large arterial territory in 8 of them, for two patients we found multilacunar infarcts. All patients had negative HIV serology and D-dimers greater than 500 μg/L. Conclusion: This work on strokes in Covid-19 infected patients shows that it is a fairly frequent neurological complication, which can occur even in young subjects without known risk factors, the symptoms of viral infection are not systematically present before the onset of stroke.

Multiple Cranial Nerve Palsies in Otolaryngology Consultation: An Atypical Clinical Presentation Revealing Myasthenia Gravis

Introduction: Myasthenia gravis is a chronic autoimmune neuromuscular disease, presents with weakness and fatigability of striated skeletal muscles. It is a rare disease in Cameroon. We report an uncommon case of myasthenia gravis in a patient with feeding difficulties, notion of oronasal reflux and swallowing disorders as first complaints. Observation: We report the case of a 29-year-old woman consulted at our department of Otolaryngology and Cervico-Facial Surgery for dysphagia and swallowing disorders. She also presented with facial diplegia, oculomotor paralysis, nasal voice, and dysarthria which has been evolving for several years now. The clinical examination revealed multiple cranial nerve palsies. The complementary workup showed a decrement of more than 50% in the electroneuromyography and the presence of anti-acetylcholine receptor autoantibodies in the blood workup. A diagnosis of myasthenia confirms clinical presumption. We initially observed a worsening of neuromuscular disorders despite the pyridostigmine treatment and subsequently a clear improvement of the clinical features concerning swallowing and speech disorders, oculomotricity and facial diplegia under a treatment combining prednisone and azathioprine. Conclusion: Myasthenia gravis is a rare and potentially fatal autoimmune neuromuscular disease. We thus highlight the atypical clinical presentation and therapeutic itinerary of our patient and the importance to think about this clinical diagnosis in front of any multiple cranial nerve paralysis in otolaryngology consultation.