Meningeal Syndrome Research Articles

P-1286. Severe Forms Of Rickettsiosis In Comparison With Non-Severe Forms

Abstract Background Rickettsiosis, a relatively benign disease, typically manifests with fever, skin rash, and headache. However, severe forms may occur, changing therefore, the prognosis of the disease. We aimed to study the clinical, biological and therapeutic characteristics of severe forms of rickettsiosis in comparison with non-severe forms. Methods We conducted a retrospective study including all patients hospitalized for rickettsiosis in infectious diseases department between 1996 and 2022. The diagnosis was confirmed by serological tests. Results We encountered 84 cases of severe rickettsiosis (17.8%) and 388 cases of non-severe forms (82.2%). The median age of patients with severe forms was 47[32-64] years and with non-severe forms was 37[25-53] years (p=0.24). Meningeal syndrome (38.1% vs 8.5%; p< 0.001) and vomiting (58.3% vs 41.9%; p=0.006) were significantly more frequent among severe cases. Maculopapular skin rash (57.1% vs 86.8%; p< 0.001) and arthralgia (58.3% vs 76%; p=0.001) were significantly less frequent among severe cases. Leukocytosis was significantly more frequent among severe forms (36.9% vs 20.6%; p=0.001). Elevated C-reactive protein levels (63.1% vs 66.2%; p=0.582), thrombocytopenia (51.8% vs 59.6%; p=0.19) and hepatic cytolysis (60.7% vs 69.8%; p=0.103) were noted among severe and non-severe forms, with no significant difference. Treatment duration was significantly longer among severe forms (10[7-14] days vs 7[5-10] days; p=0.016). Conclusion The diagnosis of severe forms of rickettsiosis should be ruled out in front of meningeal syndrome and vomiting, even in the absence of maculopapular skin rash and arthralgia, especially in the presence of leukocytosis. Disclosures All Authors: No reported disclosures

Clinical Features of Human Parvovirus B19-Associated Encephalitis Identified in the Dakar Region, Senegal, and Viral Genome Characterization.

Neurological manifestations associated with human parvovirus B19 (B19V) infections are rare and varied. Acute encephalitis and encephalopathy are the most common, accounting for 38.8% of all neurological manifestations associated with human B19V. Herein, we report on the clinical features of 13 laboratory-confirmed human cases of B19V-associated encephalitis in Senegal in the framework of a hospital-based surveillance of acute viral encephalitis conducted from 2021 to 2023. Overall, B19V was detected from 13 cerebrospinal fluid samples using specific real time PCR. The mean age was 16.7 years among B19V-positive patients, with a higher prevalence in 0-5-year-old children and the sex ratio (male/female) was 2.25. The B19V-positive patients mainly exhibited hypoleukocytosis, normal glycorrhachia, and normal proteinorrachia in the cerebrospinal fluid. While the main neurological symptoms included meningeal and infectious syndromes. Furthermore, three complete B19V genome sequences were successfully characterized using next-generation sequencing. The newly characterized sequences belonged to the genotype 1a and represent, to date, the first complete B19V genome sequences from Senegal. These sequences could be useful not only in future phylodynamic studies of B19V but also in the development of prevention or treatment countermeasures. Our study is noteworthy for the identification of acute B19V-associated encephalitis in Senegal More investigations on the risk factors associated with B19V transmission in Africa are warranted.

The impact of the number of aneurysms on the course of the acute period of subarachnoid hemorrhage in patients with multiple intracranial aneurysms

Objective to determine the effect of the number of multiple intracranial aneurysms (MIA) on the course of the acute period of subarachnoid hemorrhage (SAH). Materials and methods: A cross-sectional retrospective study was conducted involving 92 patients in the acute phase of SAH due to the rupture of MIA. Patients were divided into two groups depending on the number of aneurysms. Demographic indicators (age, gender) and clinical-instrumental factors (comorbidities, extent of hemorrhage, severity at admission, clinical manifestations), treatment characteristics, and outcomes were analyzed using descriptive statistics and logistic regression. Results: Comorbidities were 3.4 times more common among patients with three or more aneurysms (p=0.143). Patients in group 2 were 1.9 times more likely to be admitted with a World Federation of Neurosurgical Societies (WFNS) grade 2 (p=0.335). WFNS grade 3 at admission was observed twice as often in group 1 (p=0.447). Patients from group 1 and group 2 were equally likely to present with WFNS grade 4 (p=0.978). The probability of being admitted with a WFNS grade 5 was 1.8 times higher in group 2 (p=0.830). The presence of meningeal syndrome increased the risk of having 3 or more aneurysms by more than four times (OR 4.41, CI 0.41-47.13, p=0.21). The presence of motor impairments significantly reduced the risk of having 3 or more aneurysms (OR 0.63, CI 0.09-4.18, p=0.63). Patients in group 2 were slightly more likely to develop vasospasm than those in group 1 (OR 1.22, CI 0.34-4.31, p=0.752). The presence of comorbidities increased with the number of aneurysms (OR 3.42, CI 0.65-17.62, p=0.143). Conclusions: The presence of comorbidities more than triples the chances of having 3 or more aneurysms. Patients with fewer aneurysms are twice as likely to be admitted in a milder condition (WFNS grade 2). The probability of severe condition (WFNS grade 5) at hospital admission for patients in group 2 is 1.8 times higher than in group 1. The likelihood of motor disorders decreases by 4.4 times with an increasing number of aneurysms. The probability of vasospasm development slightly increased with the number of aneurysms. These data emphasize the importance of a comprehensive approach to the assessment of SAH patients and the need for careful monitoring of patients at high risk of vasospasm.

Child with Rifampicin‑Resistant Tuberculous Meningitis: A Case Report

Background: Tuberculosis remains a significant global health concern, with increasing incidence of drug-resistant strains posing challenges to effective treatment. We present a case of rifampicin-resistant tuberculous meningitis in an immunocompetent child, highlighting the severity and complexity of tuberculosis in pediatric populations. Case report: An 11-year-old child with a family history of tuberculosis was hospitalized for febrile meningeal syndrome. Symptoms included progressively developing headaches, vomiting, food refusal, and right hemiparesis over 10 days. Upon admission, the patient was conscious with a fever of 38.2°C and a stiff neck. Biological analyses revealed neutrophil-predominant hyperleukocytosis, lymphopenia, and hyponatremia. Cerebrospinal fluid analysis showed a predominance of lymphocytes and hypoglycorrhachia. The Xpert MTB/RIF ultra test confirmed tuberculous meningitis with detection of the rifampicin resistance gene. Imaging revealed active hydrocephalus. Second-line treatment was initiated, involving multiple medications over 24 months. This observation underscores the complexity of tuberculous meningitis in children, necessitating an individualized therapeutic approach. Conclusion: Drug-resistant tuberculous meningitis in children represents a complex and devastating medical challenge. Progress in diagnosis, while significant, underlines the need for a nuanced approach and ongoing research to improve screening tools.

Thrombophlebitis of the cavernous sinus in children: about a case

We report the case of a girl transferred to our department for treatment of sepsis. On admission, physical examination revealed right eyelid edema and frank meningeal syndrome. The brain CT scan then performed returned to normal. After 10 days of antibiotic therapy, in a persistent infectious context, ptosis, ophthalmoplegia and arereactive mydriasis appeared in the right eye. Brain MRI showed thrombophlebitis of the cavernous sinus. Adapted antibiotic therapy and anticoagulant treatment have been instituted. After four weeks, the outcome was favourable, marked by a complete regression of the signs, particularly ophthalmological, and a disappearance of the radiological signs of cavernous sinus thrombosis. However, sequelae quadriventricular hydrocephalus was noted. Keywords: thrombophlebitis, cavernous sinus, heparinotherapy, Senegal.

Clinical-Laboratory Outcome of Cryptococcus sp. Multifocal Choroiditis in Acquired Immunodeficiency Syndrome Patients

ABSTRACT Purpose This study aims to describe the clinical and laboratory outcomes of patients with Acquired Immunodeficiency Syndrome (AIDS) presenting multifocal choroiditis secondary to Cryptococcus sp. infection. Methods We reviewed the clinical records of AIDS patients diagnosed with cryptococcal multifocal choroiditis at the Laboratory of Infectious Disease in Ophthalmology, Oswaldo Cruz Foundation, from January 2022 to March 2024. Patients meeting the criteria of typical fundus appearance associated with disseminated cryptococcosis laboratory diagnosis were included. Data collected included age, gender, symptoms, plasma HIV viral load, serum T-CD4+ cell count (cells/mm3), initial visual acuity (VA), laboratory methods for cryptococcosis diagnosis, treatment, and final VA. All patients underwent multimodal evaluation including spectral domain optical coherence tomography, fluorescein angiography (FA), and indocyanine green angiography (ICG). Results Six patients were evaluated, comprising five males (83%) and one female (17%), with a mean age of 36.5 years (standard deviation, SD: 10,46). Five patients (83%) presented with meningeal syndrome. Mean HIV plasma viral load was 262.959 copies/mm3 (SD: 209.469), and the mean serum T-CD4 count was 13.33 cells/mL (SD: 14,63). All patients tested positive for serum cryptococcal antigen (CRAG). Four patients (67%) had positive cerebrospinal fluid (CSF) culture and CRAG. Treatment included intravenous Amphotericin B and oral Fluconazole. Among twelve eyes (100%), four (33%) achieved visual recovery, while eight (67%) maintained initial VA. Lesions were more numerous and distinct on ICG compared to fundus examination and FA. Conclusion This study underscores the importance of clinical, laboratory, and multimodal evaluations in AIDS patients presenting with cryptococcal multifocal choroiditis.

LIMPACT DE LA VACCINATION ANTI-PNEUMOCOCCIQUE SUR LES MENINGITES A PNEUMOCOQUE A MARRAKECH

Introduction: Pneumococcal meningitis is a worldwide scourge in children under 5 years of age. The advent and introduction of pneumococcal conjugate vaccines has led to considerable progress in the prevention of PNO meningitis. In Morocco, a new 13-valent vaccine was introduced in February 2023 including pneumococcal polysaccharide of 13 serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F) on a 4-dose vaccine schedule thus covering more serotypes and providing more protection. The objective of our study is to determine the impact of pneumococcal vaccination on pneumococcal meningitis in Marrakech and to identify new non-vaccinated serotypes. Patients and Methods: This is a retrospective and descriptive study carried out in children hospitalized in the pediatric department A at the Mohammed VI University Hospital Marrakech for pneumococcal meningitis over a period of 12 years from February 21, 2010 to December 21, 2022. Results: During this period, 140 confirmed pneumococcal meningitis cases were recorded. The mean age of the children was 3.5 years. Pneumococcal meningitis mainly affected children under 1 year of age in 46% of cases. The presenting signs of PNO meningitis in our series were predominantly acute fever, febrile meningeal syndrome and convulsions. Between 2010 and 2022, 95 strains isolated from CSF were serotyped. There was a significant regression of vaccine serotype meningitis between 2010 and 2014 and an increase in non-vaccine serotype meningitis starting in 2015. Serotypes 3,19 A, 6A were maintained between 2010 and 2022.The predominant serotypes in meningitis were serotypes 23F, 15, 19NV, 6B, 3, 19A, 11A. The evolution was marked by the occurrence of sequelae in 38% of cases, and 8% of death. Conclusion: Following the introduction of the 13-valent pneumococcal conjugate vaccine, a significant decrease in pneumococcal meningitis caused by the vaccine serotypes has been observed. However, efficacy data remain scarce warranting continued monitoring to assess the effectiveness of vaccination in improving protection against pneumococcal meningitis.

Meningeal Syndrome with Bilateral Visual Loss Secondary to Meningococcal Meningitis in an Immunocompetent Young Adult: Uncommon Presentation

Meningeal Syndrome with Bilateral Visual Loss Secondary to Meningococcal Meningitis in an Immunocompetent Young Adult: Uncommon Presentation

Listeria Rhombencephalitis: A Case of an Immunocompetent Adult

Listeriosis is one of the most important foodborne diseases, caused by a Gram-positive facultative anaerobic intracellular bacterium found in food and the environment, Listeria monocytogenes. It causes one of the most life-threatening bacterial infections of the central nervous system (CNS). Meningoencephalitis and rhomboencephalitis are the most common forms and immunosuppression represents the main risk factor. In this article, we report a case of severe, invasive Listeria monocytogenes rhombencephalitis in a healthy middle-aged man, admitted to our hospital with meningeal syndrome associated with left VI nerve palsy. No apparent abnormality was found in a head CT and brain magnetic resonance imaging. Following the preliminary LP results, a diagnosis of bacterial meningitis was suspected and empirical antibiotic and antiviral therapy was initiated. Because of the lack of any significant improvement in his clinical status, on day 2 of his admission, a genetic identification of CSF pathogens by high-throughput genome sequencing was performed and identified L. monocytogenes. The Clinical status improved with complete recovery after appropriate antibiotic treatment with sulfamethoxazole-trimethoprim. In conclusion, in an infectious context, pontine involvement should systematically evoke the diagnosis of listeriosis.

The impact of meningeal syndrome on the course of aneurysmal subarachnoid hemorrhage

The impact of meningeal syndrome on the course of aneurysmal subarachnoid hemorrhage

Moya –Moya disease revealed by a subarachnoid hemorrhage: A case report

Background: Hemorrhage is a major category of the clinical symptoms of moyamoya disease (MMD). Intracerebral and intraventricular hemorrhages are the most common hemorrhages in MMD, and subarachnoid hemorrhages (SAHs) are notably rare. Case report: A 43 year old female patient, with no previous pathological history, admitted with a frank meningeal syndrome followed by a disorder of consciousness.She was admitted with a GCS at 15, which was subsequently reduced to 10. She was hemodynamically and respiratory stable with a BP of 12/8 cm/Hg, a respiratory rate of 16 cycles/min and a heart rate of 92 beats/min. Initial imaging showed subarachnoid hemorrhage Fisher IV. A cerebral angiography-CT showed vascular thrombosis of the internal carotid artery whitout aneurysm and arteriovenous malformation and dural fistulas. An EVD (external ventricular drain) was placed. After three days of hospitalization in the intensive care unit, a cerebral arteriogram was performed showing vascular arrest in the right internal carotid artery in its pre-cavernous portion with absence of visualization of the right sylvian artery and the presence of several perforating cerebral artery and external carotid artery bypass systems suggestive of Moya Moya. Conclusion: Moya Moya disease is a rare entity of unknown origin. Subarachnoid hemorrhage is a rare manifestation. It’s mainly occurs in a young adult. Cerebral angiography remains the gold standard for diagnosis.

1775. Predictor Factors Of Severe Forms Of Rickettsial Infections

Abstract Background Rickettsial infections usually mimic benign viral infection due to similarities in clinical symptoms. However, severe forms and complications might occur changing therfore the prognosis of the disease. We aimed to study the predictor factor of severe forms of rickettsial infections. Methods We conducted a retrospective study including all patients hospitalized in the infectious diseases department for rickettsiosis. The diagnosis was confirmed by serologies (seroconversion) and/or positive polymerase chain reaction for Rickettsia in skin biopsy. Severe forms included cases with acute respiratory distress syndrome, myocarditis, meningitis, meningoencephalitis, renal failure or septic shock. Results We encountered 472 cases among which 98 cases were severe (20.8%). Median age was 43[25-60] years among severe forms and 38[24-53] years among non-severe forms (p=0.132). Maculopapular skin rash (56.7% vs 88% ; p< 0.001), arthralgia (56.1% vs 77.3% ; p< 0.001) and eschar (16.3% vs 27% ; p=0.029) were significantly less frequent among severe forms. Meningeal syndrome (34.7% vs 8.3% ; p< 0.001), vomiting (56.1% vs 41.8% ; p=0.011) and cough (28.6% vs 13.9% ; p=0.001) were significantly more frequent among severe forms. Leukocytosis was significantly more frequent among severe forms (35.7% vs 20.6% ; p=0.002). The optimal cut-off value of white blood cell count for predicting severe forms was 7595/mm3, with a sensitivity of 61.9% and a specificity of 59.7%. The area under the curve was 0.622 and the 95% confidence interval ranged from 0.558 to 0.686. Elevated C-reactive protein levels (66.3% vs 65.5%; p=0.879) and accelerated erythrocyte sedimentation rate (36.7% vs 40.1%; p=0.543) were noted among severe and non-severe forms of rickettsiosis, with no significant difference. Conclusion The revealing symptoms of severe forms were characterized by the presence of vomiting, cough and meningeal syndrome, in the absence of the typical maculopapular skin rash and eschar. Leukocytosis was more frequent among severe forms of rickettsiosis. The diagnosis of severe forms should be kept in mind in order to promptly initiate the adequate treatment. Disclosures All Authors: No reported disclosures

Meningeal Syndrome as the Debut of Multiple Myeloma, Case Report

Multiple myeloma (MM) is a monoclonal gammopathy characterized by malignant proliferation of plasma cells. Considered the second most common hematological neoplasm. Symptoms result from infiltration of plasma cells and secreted monoclonal proteins or interaction of plasma cells with their microenvironment. The classic CRAB criteria (Hypercalcemia, renal failure, anemia and lytic lesions), with renal failure being one of its most frequent complications, are necessary to establish the diagnosis. Our report presents the case of a man in his seventh decade of life, who presented with meningeal syndrome, which motivated the study approach, reaching the conclusion that this entity was due to a state of immunosuppression secondary to multiple myeloma, whose diagnostic suspicion was a finding that was obtained when doing a comprehensive study of the disease, since reaching the diagnosis in this case was a cause of controversy as it had an unusual presentation. This is a good case to discuss differential diagnoses and teaches us that in medical practice we deal with patients and not with diseases, since these debut in a particular way in each individual.

MAGLIO study: epideMiological Analysis on invasive meninGococcaL disease in Italy: fOcus on hospitalization from 2015 to 2019.

This study analyzed hospital admissions for invasive meningococcal disease (IMD) in epidemiological and economic terms in Italy from 2015 to 2019. The volume of acute admissions for meningococcal diagnosis was analyzed in the period from 2015 to 2019. IMD admissions were identified by ICD-9-CM diagnoses. Costs were assessed using current DRG tariffs. In 2019, a total of 237 admissions for meningococcal disease were recorded in Italy. The mean age of patients was 36.1years. Lumbar puncture was reported in only 14% of hospital discharge forms. From 2015 to 2019, there was a mean annual reduction of - 1.2% nationally for IMD hospitalizations. For 2019, the total costs for acute inpatient admissions were €2,001,093. Considering annual incidence due to IMD, a significant decrease was noted in the age group from 0 to 1year (p = 0.010) during 2015-2019. For all years, mortality associated with meningeal syndrome was lower compared to septic shock with or without meningitis. From 2015 to 2019, hospitalizations for IMD appear to be decreasing slightly in Italy, even if mortality remains high. Favorable trends in hospitalizations for IMD were seen in the 0-1-year age group, which may be attributable to increased vaccination. Costs of hospitalizations for IMD remain high.

Resistant Tuberculosis in HIV-Positive Patients: A Growing Public Health Threat

<i>Introduction: </i>Tuberculosis (TB) is a pathology considered one of the main causes of death by single infectious agent, ranking just after HIV / AIDS. Indeed, its emergence and the difficulty of its treatment, especially in the resistant form, in patients with co-infection with other diseases immundéprimante as HIV.<i> Observation 1:</i> 31 years old presented with febrile headaches complicated by epileptic seizures. The MRI scan showed 3 cockeyed and multilocular lesions suggesting neuromeningeal tuberculosis. HIV serology came back positive and during the first line treatment he relapsed and the resistance test was positive.<i> Observation 2:</i> 45 progressive alteration of the state associated with signs of tuberculosis impregnation and a meningeal syndrome. BK in the CSF and in the sputum was positive and brain imaging allowed us to retain the diagnosis of a neuromeningeal tuberculosis. The patient was put on anti-bacillary ERIP k4 and a corticotherapy. The workup for co-infection was able to establish an HIV infection. After 3 weeks of anti-bacillary treatment, the patient had a bad evolution and the search for resistance came back positive. <i>Observation 3: </i>25 years old, pulmonary tuberculosis manifested by a hemoptysis of small abundance associated with a deep alteration of the general state, 3 BK positive sputum, as well as the image of a tuberculous cavern on the thoracic CT. Bad evolution after 2 months of treatment of first worsening of symptoms neuro and systemic involvement the search for resistance came back positive. <i>Discussion:</i> Drug-resistant tuberculosis is a major global public health challenge. In this article, we present three cases of drug-resistant TB in HIV-coinfected patients, highlighting the emergence and increasing prevalence of multidrug-resistant TB (MDR-TB) strains worldwide. In order to control the spread of this dreaded disease, it is essential to improve treatment regimens, promote vaccination, educate affected patients, and promote adherence to treatment. <i>conclusion: </i>Diagnosis of drug-resistant tuberculosis should be prompt and considered if there is a delay or lack of improvement with conventional tuberculosis treatment.

HAEMOPHILUSINFLUENZAE TYPE B MENINGITIS REVEALING HYPOGAMMAGLOBULINEMIA IN A VACCINATED CHILD

Haemophilusinfluenzae type b (Hib) meningitis is a major therapeutic emergency, and its incidence has been significantly reduced by vaccination.We report the case of a 4-year-old girl vaccinated against Hib, hospitalized for Haemophilus influenza type b meningitis revealed by a febrile meningeal syndrome and having revealed a hypogammaglobulinemia. The child was treated with antibiotic therapy associated with corticosteroid therapy and immunoglobulin substitution with a good evolution. Through this observation we conclude that the assessment of the immune deficiency must be systematically proposed in front of a neuromeningeal infection with Hib.

A Rare Case of Meningoencephalo-Myelitis with a Tubercular Origin

Tuberculosis (TB) can affect any bodily system including the central nervous system (CNS). CNS involvement in Tb is fairly uncommon with poor prognosis due to its high mortality and morbidity. Though meningoencephalitis is a frequent presentation of TB, myelitis along with it is rare. Due to the lack of detailed information about meningoencephalo-myelitis, the risk factors and prognosis of these patients are not fully understood. We report such a rare instance of tuberculosis involving the brain, meninges and spinal cord. The patient was a 13-year-old female with the complaints of fever, both lower limb weakness and urinary retention. The diagnosis was made based on the patient’s medical history and physical examination which showed meningeal syndrome, spinal cord and cranial nerve involvement. The diagnosis was confirmed by the analysis of cerebrospinal fluid, magnetic resonance imaging of the brain and spinal cord, and biochemical evidence of tuberculous infection. The patient had a marked clinical improvement and complete neurologic recovery after anti-tubercular treatment and high doses of systemic corticosteroids. The purpose of presenting the case is to share the bizarre presentation of CNS tuberculosis, a diagnostic and therapeutic emergency. Early diagnosis and immediate management may help with the unfavorable prognosis and our report hopes to shed light on it. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 225

Reversible Posterior Encephalopathy Syndrome Secondary to Post-Streptococcal Acute Glomerulonephritis in a Child: About an Unusual Case Report and Review of Literature Oumou Maïga, Marwa El Massi, Moussa Coulibaly, Soumia Mghar, Karima El Fakiri, Nouredine Rada, Ghizlane Draiss, Dounia Basraoui, Mohamed Bouskraoui Published: May 6, 2023 | 7 5 DOI: 10.36347/sasjm.2023.v09i05.007 Pages: 434-426 Downloads Abstract Reversible posterior encephalopathy (PRES) is a

Reversible posterior encephalopathy (PRES) is a clinico-radiological syndrome, which manifests as headaches, confusion, visual disturbances, convulsive seizures and radiological abnormalities of the white substance suggesting oedema of the posterior parieto occipital brain regions. It is a poorly known and very rare disease in children. In a 10-year-old boy with an untreated 15-day history of angina, he presents for headaches, associated with vomiting, or even photophobia-type visual disorders and earache-type otalgia and phonophobia, a disorder of conscience of more than 24 hours without the notion of convulsions and a hematuria in broth dirty. All associated with functional impotent of the lower limbs and meningeal syndrome. Cerebral MRI showed a signal abnormality in cortical subcortical range visible in bilateral parieto-occipital, T2 hypersignal and flair with discrete under cortical restriction of diffusion and not raised after injection. We are bringing a case of reversible posterior encephalopathy secondary to acute glomerulonephritis post-streptococcal associated with a meningeal syndrome that could likely be related to germless bacterial meningitis or meningeal hemorrhage. Early detection and prompt treatment are important measures to reduce morbidity and mortality.

Neurobrucellosis Presenting With Isolated Intracranial Hypertension (P3-10.005)

<h3>Objective:</h3> To indicate that isolated intracranial hypertension can be the only symptom of neurobrucellosis. <h3>Background:</h3> Neurobrucellosis is a frequent infection in the Mediterranean countries but it is under-diagnosed because of its clinical polymorphism. Clinical manifestations are very different in relation to meningeal, parenchymal or vascular involvement. Isolated intracranial hypertension is a rare symptom. <h3>Design/Methods:</h3> We report the case of a young man with neurobrucellosis who presented with isolated intracranial hypertension without other systemic symptoms of brucellosis. <h3>Results:</h3> A 32-year-old man with no medical history was referred to our department for headache and binocular diplopia evolving for 1 month. There was no history of drug use, consumption of raw milk, or weight gain or loss. Clinical examination showed bilateral stage II papilledema with a left VI nerve palsy. The patient had no meningeal syndrome or organomegaly. There was no fever. An intracranial hypertension was suspected and the patient was hospitalized. Cerebral magnetic resonance imaging was normal. The opening cerebrospinal fluid (CSF) pressure was 45 cmH₂O. Microscopic examination of the CSF revealed 113 cells/mL with lymphocytic predominance and negative culture. Protein level was 1.19 g/l, glucose level was 0.54 mmol/l (ratio at 0.09). Wright test was positive at 1/5120 titer in serum. The patient was diagnosed with neurobrucellosis and was treated with Doxycycline and Rifampicin with good clinical evolution. <h3>Conclusions:</h3> The incidence of neurobrucellosis ranges between 1.7–10%. Chronic meningitis with intracranial hypertension has been rarely described as the initial manifestation of neurobrucellosis. The evolution is favorable in more than 50% of cases after appropriate antibiotic therapy. Early diagnosis and appropriate management are important. <b>Disclosure:</b> Nesrine Charfi has nothing to disclose. Sawsan Daoud has nothing to disclose. Nadia Bouattour has nothing to disclose. Salma Sakka has nothing to disclose. khadija maalla has nothing to disclose. mariem damak has nothing to disclose. Prof. Mhiri has received personal compensation for serving as an employee of Hikma. Prof. Mhiri has received personal compensation for serving as an employee of Sanofi Genzyme. Prof. Mhiri has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Prof. Mhiri has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche.

Ischemic Stroke Complicating Neuromeningeal and Pulmonary Tuberculosis in Children: About a Case in Senegal

Tuberculosis is a major public health problem, especially in developing countries. Neuro-meningeal involvement is rare but represents one of the most severe forms with high morbidity and mortality. We report the case of an ischemic stroke complicating neuromeningeal and pulmonary tuberculosis in a four-month-old infant at the National Hospital Center of children Albert Royer (Senegal). The case was a four-month-old, male infant with no history. His vaccination was up to date according to Senegal’s expanded vaccination program. There was no notion of tuberculosis contagion. He was seen for a prolonged fever for more than a month and chronic cough. He had moderate malnutrition. Neurological examination revealed coma, meningeal syndrome, generalized tonic convulsions and hypertonia. The pupils were in bilateral miosis. Osteotendinous reflexes were abolished with a bilateral Babinski sign. He also had severe respiratory distress, bilateral pulmonary condensation syndrome. Brain computed tomography was in favor of an ischemic stroke. The test GeneXpert MTB/RIF was positive on cerebrospinal fluid and gastric tubing fluid. The curative treatment was based on a quadruple therapy based on rifampicin, isoniazid, pirazinamide and ethambutol. The evolution was unfavorable with the death of the patient.