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Case Report
Challenges in Diagnosing and Managing Delayed Onset Paroxysmal Generalized Dystonias Associated with Bilateral Thalamic Hemorrhagic Venous Infarction Due to Extensive Cerebral Venous Thrombosis (CVT) in a 15-Year-Old Adolescent: A Case Study
Issue:
Volume 13, Issue 1, March 2025
Pages:
1-6
Received:
7 December 2024
Accepted:
23 December 2024
Published:
9 January 2025
DOI:
10.11648/j.ajpn.20251301.11
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Abstract: Cerebral venous thrombosis (CVT) constitutes less than 1% of stroke occurrences. The prevalence of abnormal movements following a stroke remains unclear, with movement disorders observed after a stroke ranging from 13 to 22% of secondary disorders. Nonetheless, these disorders are present in only 1% to 4% of stroke cases, with dystonias being the most commonly linked abnormalities in ischemic strokes. The lesions that lead to dystonias primarily affect the basal ganglia, thalamus, brainstem, cerebellum, and specific cortical regions. Dystonias make up about 30% of abnormal movements observed after a thalamic stroke, with the lesions typically being unilateral. This research discusses instances of delayed paroxysmal dystonias related to bilateral hemorrhagic infarction in the thalamus of an adolescent with cerebral venous thrombosis. A 15-year-old adolescent was admitted due to a rapidly developing disturbance of consciousness. Upon arrival, he exhibited a non-massive left hemicorporal pyramidal syndrome, left-sided tonic seizures, and a state of confusion. Magnetic resonance imaging revealed a bilateral thalamic hemorrhagic focus and cerebral venous thrombosis. Anticoagulant therapy was initiated, and the clinical progression during the acute phase was satisfactory. Ten days later, the patient displayed generalized but asymmetrical paroxysmal dystonias, predominantly affecting the left hemibody. This case presented diagnostic challenges, as the abnormal dystonic movements were linked to focal tonic seizures, alongside management issues, given that most antidystonic medications are sedative in nature, complicating treatment due to the pre-existing disturbance of consciousness. Nevertheless, the patient's condition improved under cautious administration of anticholinergic agents and GABAergic agonists.
Abstract: Cerebral venous thrombosis (CVT) constitutes less than 1% of stroke occurrences. The prevalence of abnormal movements following a stroke remains unclear, with movement disorders observed after a stroke ranging from 13 to 22% of secondary disorders. Nonetheless, these disorders are present in only 1% to 4% of stroke cases, with dystonias being the m...
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Research Article
General Practitioners' Knowledge in the Management of Headaches on First Contact Health Centres in Abidjan, Ivory Coast
Issue:
Volume 13, Issue 1, March 2025
Pages:
7-15
Received:
22 December 2024
Accepted:
6 January 2025
Published:
11 February 2025
Abstract: Background: Headaches can be detrimental to patients if they are inadequately managed. Objective: Our aim was to study the diagnostic and therapeutic knowledge of General Practitioners (GPs) in relation to headache. Methods: We conducted a cross-sectional, descriptive, questionnaire-based study of general practitioners from 1 January to 28 February 2022 in Abidjan. The questionnaire focused on the type of headache patients present to the clinic and GPs' diagnostic and therapeutic pattern with regard to headache. Results: 200 GPs were surveyed. In terms of diagnostic habits, GPs had poor habits regarding the characteristics of headaches, apart from the site, type and duration, which were ‘always’ sought in 79.5%, 74.5% and 70% of cases respectively. They were also not very familiar with the patient's history, apart from high blood pressure, which was ‘always’ sought in 78.5% of cases. Regarding headache disability, the habit was poor, as it was assessed ‘always’ and ‘often’ in 2.5% and 48% of cases respectively. GPs were also unaccustomed to physical examination for neurological signs, with motor deficit and meningeal syndrome ‘always’ sought by 10.5% and 11% of GPs respectively. Indications for prescribing brain imaging were followed by GPs in 38.1% of cases. As for treatment habits, WHO level 1 analgesics were ‘always’ prescribed in 70% of cases, and level II analgesics ‘often’ prescribed in 68% of cases. Level 3 analgesics and Co analgesics were ‘never’ prescribed in 44% and 87.5% of cases respectively. Headache patients were mainly referred to neurologists (96%). Conclusion: This study highlighted a lack of diagnostic and therapeutic knowledge. This suggests that GPs should be given more training to improve headache management.
Abstract: Background: Headaches can be detrimental to patients if they are inadequately managed. Objective: Our aim was to study the diagnostic and therapeutic knowledge of General Practitioners (GPs) in relation to headache. Methods: We conducted a cross-sectional, descriptive, questionnaire-based study of general practitioners from 1 January to 28 February...
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Research Article
Evaluation of the Practice of CT-guided Lumbar Infiltration at the Mother Hospital Center Child “The Luxemburg”
Mariko Mahamane,
Camara Mamoudou*
,
Maiga Abdoul Salam,
Diallo Seydou Alassane,
Abdoul Nasser Kimba Bana,
Keita Adama Diaman,
Dena Emmanuel
Issue:
Volume 13, Issue 1, March 2025
Pages:
16-23
Received:
5 January 2025
Accepted:
22 January 2025
Published:
17 February 2025
Abstract: The objectives of this study were to determine the main indications for CT-guided lumbar infiltrations, to list the clinical picture post-CT-guided lumbar infiltration and to describe the intensity of pain post-CT-guided lumbar infiltration in the radiology department. This was a descriptive study to be collected prospectively over a period of seven months from June 2023 to December 2023 relating to CT-guided lumbar infiltration in the radiology and medical imaging department of the Mother Hospital. Child “Luxembourg”. It focused on patients aged 20 to 80 years and over, admitted and having performed a CT-guided infiltration in our department during the period. We glued 50 patients during our study. The 40-59 age group was the most common, at 54%. There is a male predominance with a sex ratio equal to 1.08. The maximum number of patients came from the neurology department (78%). Patients without medical care were the most represented, i.e. 60%. 64% of our patients have not had any infiltration in the last six months. Patients with pain lasting less than 6 months were the most represented, i.e. 40%. The level of pain intensity increasing between 5-7 (severe pain) was the most represented, i.e. 58%. The visual analog scale after three months was estimated between 1-3 and was the most represented, i.e. 70%. The visual analog scale (VAS) estimated between 3-5 after one month was the most represented, i.e. 66%. Discopathy represented 47% followed by the combination of herniated disc and disc disease, i.e. 26.4%. The lesions were more localized at the L5-S1 level, i.e. 62%. Epidural infiltration was performed in 66% of our patients. The complication rate was 0% due to the strict hygiene conditions applied for each procedure. Infiltration is very important in the treatment of active disc disease. Our study demonstrates that epidural infiltrations can be an alternative in the overall management of inflammatory disc disease.
Abstract: The objectives of this study were to determine the main indications for CT-guided lumbar infiltrations, to list the clinical picture post-CT-guided lumbar infiltration and to describe the intensity of pain post-CT-guided lumbar infiltration in the radiology department. This was a descriptive study to be collected prospectively over a period of seve...
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Research Article
Dreams as Intersubjective Dialogic Experiences in Psychoanalytic Phenomenology
Issue:
Volume 13, Issue 1, March 2025
Pages:
24-31
Received:
1 January 2025
Accepted:
27 January 2025
Published:
21 February 2025
Abstract: Dreams are part of our lives. Day and night, we live with them. Dreams are personal and significant to the individual who is dreaming them. The psychological significance of dreams is evident in the unconscious thoughts of our inner concerns, worries, fears, wishes, expectations, and fantasies. No one should underestimate the value of dreams in their lives because they can provide the right direction towards the domains of our lives that require attentiveness, significant associations, or characteristics of ourselves that we are worried about. The significance of dream research primarily lies in its unique and distinctive research methodology, which combines quantitative and qualitative approaches. Most importantly, attempting to synthesize phenomenological psychology and psychoanalytic psychology as an alternative qualitative methodology to explore the beliefs and conceptions of children and adults has added much value to recent research work. Psychoanalytic phenomenological investigations search for meaning, aiming to describe, explicate, and understand dream experiences. This approach seeks to capture the experiences of individuals as they experience them, primarily through reflective analysis of experience and meaning. Such hybrid methodologies are well suited to investigating unconscious representational processes and internal representations of self and others.
Abstract: Dreams are part of our lives. Day and night, we live with them. Dreams are personal and significant to the individual who is dreaming them. The psychological significance of dreams is evident in the unconscious thoughts of our inner concerns, worries, fears, wishes, expectations, and fantasies. No one should underestimate the value of dreams in the...
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Review Article
Psychopharmacology as a Tool for Understanding the Pathophysiology of Anorexia Nervosa
Uri Eliyahu*
Issue:
Volume 13, Issue 1, March 2025
Pages:
32-35
Received:
3 February 2025
Accepted:
26 February 2025
Published:
11 March 2025
DOI:
10.11648/j.ajpn.20251301.15
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Abstract: Anorexia nervosa (AN) is a body image disorder that manifests itself in the feeling that one is obese, even though the objective reality shows otherwise. People with AN resort to preventive behavior (restriction of food intake) or processes that encourage weight loss (use of medications such as diuretics and laxatives or obsessive engagement in vigorous physical activity). Among the mental disorders, AN is characterized by a high percentage of suicidal rate. Drug treatment began with the antihistamine drug Cyproheptadine. As expected, it increased the appetite of AN patients. However, it did not treat the body dysmorphic disorder accompanied by a concomitant depressive disorder and irrational thinking. After that, the treatment was changed to Tri-Cyclic Antidepressants (TCAs). The TCAs exposed the patients to cardiac arrhythmias (due to electrolyte imbalance). Serotonin reuptake inhibitors (SSRIs) slightly improved mood, while Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) increased metabolic rate (which is not desirable). The drug Bupropion, as a representative of Dopamine and Noradrenaline Reuptake Inhibitors (DNRIs), pointed to the imbalance in Dopamine levels in different brain regions as one of the main contributors to the pathophysiology of AN disease. This discovery led to the use of the second-generation antipsychotic drugs as very beneficial strategy.
Abstract: Anorexia nervosa (AN) is a body image disorder that manifests itself in the feeling that one is obese, even though the objective reality shows otherwise. People with AN resort to preventive behavior (restriction of food intake) or processes that encourage weight loss (use of medications such as diuretics and laxatives or obsessive engagement in vig...
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