Une méningovascularite infectieuse de Lyme révélée par des accidents ischémiques cérébraux successifs

Introduction

Infectious vascularitis is an unusual cause of ischemic stroke (IS). We report a case of Lyme meningovascularitis complicated with multiple IS.

Case report

A 64-year-old man, without any cardiovascular risk factor, was admitted for a right hemiparesia with a left thalamic hypodensity on the initial cerebral CT scan. No cause for this presumed IS could be identified. Later, the patient developed cognitive impairment and a bilateral cerebellar syndrome. Multiple infarcts and multiple intracranial stenosis were seen on cerebral MRI with magnetic resonance angiography (MRA). Cerebrospinal fluid tests showed meningitis and positive Lyme serology with an intrathecal specific anti-Borrelia antibody index. Antibiotic treatment was followed by good biological and partial clinicoradiological outcome.

Conclusion

The diagnosis of Lyme neuroborreliosis should be entertained as a possible cause of IS in highly endemic zones.     

Non‐specific effects of diphtheria‐tetanus‐pertussis and measles vaccinations? An analysis of surveillance data from Navrongo,Ghana

Objectives Studies from low‐income countries have suggested that routine vaccinations may have non‐specific effects on child mortality; measles vaccine (MV) is associated with lower mortality and diphtheria‐tetanus‐pertussis (DTP) with relatively higher mortality. We used data from Navrongo, Ghana, to examine the impact of vaccinations on child mortality. Methods Vaccination status was assessed at the initiation of a trial of vitamin A supplementation and after 12 and 24 months of follow‐up. Within the placebo group, we compared the mortality over the first 4 months and the full 2 years of follow‐up for different vaccination status groups with different likelihoods of additional vaccinations during follow‐up. The frequency of additional vaccinations was assessed among children whose vaccination card was seen at 12 and 24 months of follow‐up. Results Among children with a vaccination card, more than 75% received missing DTP or MV during the first 12 months of follow‐up, whereas only 25% received these vaccines among children with no vaccination card at enrolment. Children without a card at enrolment had a significant threefold higher mortality over the 2‐year follow‐up period than those fully vaccinated. The small group of children with DTP3‐4 but no MV at enrolment had lower mortality than children without a card and had the same mortality as fully vaccinated children. In contrast, children with 1–2 DTP doses but no MV had a higher mortality during the first 4 months than children without a card [MRR = 1.65 (0.95, 2.87)]; compared with the fully vaccinated children, they had significantly higher mortality after 4 months [MRR = 2.38 (1.07, 5.30)] and after 2 years [MRR = 2.41 (1.41, 4.15)]. Children with 0–2 DTP doses at enrolment had higher mortality after 4 months (MRR = 1.67 (0.82, 3.43) and after 2 years [MRR = 1.85 (1.16, 2.95)] than children who had all three doses of DTP at enrolment. Conclusions As hypothesised, DTP vaccination was associated with higher child mortality than measles vaccination. To optimise vaccination policies, routine vaccinations need to be evaluated in randomised trials measuring the impact on survival.     

Schizophrénie et réadaptation. Interventions spécifiques selon les phases de la maladie

This article briefly overviews the main interventions available for the rehabilitation processes in patients suffering from schizophrenia. Each intervention mode is exposed with regards to the evolution stage, from the first psychotic episode to the relapse prevention phase. The psychosocial resources (family, community, individual) that can be called upon in the rehabilitation period are dealt with more precisely. Special attention was also given to the main cognitive behaviour therapies currently used in the treatment of psychosis.