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Stroke is the leading cause of epilepsy in the elderly, ahead of degenerative diseases, tumors and head injuries. It constitutes a significant complication and a considerable comorbidity. The aim of our study was to describe the main factors implicated in the occurrence of post-stroke seizures and to identify the predictors of seizure recurrence. We conducted a descriptive, retrospective, monocentric study from January 2010 to December 2019, including patients who presented seizures following an ischemic stroke. We classified these seizures according to the International League Against Epilepsy (ILAE) into acute symptomatic seizures (ASS) if they occur within seven days of stroke, and unprovoked seizures (US) if they occur after more than one week. Clinical, para-clinical, therapeutic and follow-up data were statistically analyzed and compared. A total of 52 patients were included (39 men, 13 women; median age 55.1 years). 21 cases (40%) had ASS and the remaining 31 cases (60%) presented US. Young age below 65 years (71%), middle cerebral artery infarcts (83%), and cortical localization (87%) were the main factors depicted in our series. Parietal lobe infarction was more associated with US than ASS (p = 0.035). 24 patients (46%) have presented a recurrence of seizures (8/21 of ASS and 16/31 of US). The use of sodium valproate in monotherapy was identified as a recurrence risk factor (p = 0.013). In patients with post-stroke seizures, parietal lobe infarcts are more associated with US. We identified a higher risk of seizure recurrence in patients treated with sodium valproate monotherapy.

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Parsonage-Turner syndrome (PTS) is a peripheral inflammatory neuropathy of unknown etiology. We present a rare case of a 50-year-old male patient with PTS post-COVID-19 BNT162b2 mRNA vaccine. Symptoms occurred 15 days after the second dose. He was treated with corticosteroids, analgesics, and physical rehabilitation with a partial recovery.

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BACKGROUND: Data from African countries regarding diagnosis, prognosis, management, and outcome of patients with cerebral venous thrombosis (CVT) are limited. The aim of the present study is to characterize clinical presentation, predisposing factors, neuroimaging findings, and outcomes of the disease in the Tunisian population. METHODS: This is a prospective study including patients referred to the Neurology Department of the Military Hospital of Tunis between January 2009 and December 2012. The diagnosis of CVT was confirmed in all patients using magnetic resonance imaging and magnetic resonance venography. The demographic, clinical, radiological, and outcome data were recorded and analyzed. Median follow-up was 16 months (range 6 months to 4 years). Primary outcome was death or dependency as assessed by modified Rankin score more than 2 at the end of follow-up. RESULTS: This study included 41 patients with CVT. Mean age was 41.24 years, predominantly women (68%). The mode of onset was acute in 10 patients (24%), subacute in 26 (64%), and chronic in 5 (12%). The most common presenting features were headache, observed in 83% of the patients, followed by seizures, focal motor deficits, papilledema, and mental status changes. Lateral (56%) and superior longitudinal (51%) sinuses were the most commonly involved. Multiple sinuses were involved in 46% of cases. Nineteen patients (46%) had a D-dimer level more than 500 ng/mL. Major causes of CVT were thrombophilia (56%), either genetic or acquired, obstetric and gynecological (50%), and septic (34%). Outcome was favorable in 83% of patients. At the end of follow-up, 32 patients (78%) had complete recovery (modified Rankin Scale [mRs] score 0-1), 2 (5%) had partial recovery (mRs score 2), and 4 (10%) were dependent (mRs score 3-5). One patient (2.5%) had a recurrent sinus thrombosis. CONCLUSIONS: Our Tunisian population presented distinct risk factors profile with high frequency of thrombophilia, infections, and postpartum state. Oral contraceptive use is not a major risk factor in our population. The overall prognosis was good.

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Cerebral venous thrombosis (CVT) has been associated with thrombophilic defects. We performed a study to evaluate the role of three single nucleotide polymorphisms (SNP), factor V Leiden G1691A (FVL), prothrombin gene mutation G20210A (FII-G20210A) and methylenotetrahydrofolate reductase variant C677T (MTHFR-C677T), as risk factors for CVT in Tunisian patients. A single center case-control study (26 patients with CVT and 197 controls) was performed. Genomic DNA was tested for the three SNP. The principle finding was the association between FVL and CVT (p<0.001, Odds ratio=6.1, 95% confidence interval=2.3-16.5). However, neither the FII-G20210 (p=0.536) nor the homozygous MTHFR-C677T genotype (p=0.325) variant contributed to the risk of CVT in these Tunisian patients.

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Cerebral venous thrombosis (CVT) is a rare disease. It has numerous and complex etiologies. Inherited or acquired prothrombotic states play a key role in the development of this disease, such as factor V G1691A mutation (FV Leiden). A 15-year-old girl presented to the Department of Neurology with a complaint of severe headache with visual blurring. The diagnosis of CVT was not initially suspected because of the patient's condition on presentation. An MRI showed thrombosis in the superior sagittal sinus, confirming venous stroke. Anticardiolipin and antiphospholipid antibodies were assessed. In addition, inherited prothrombotic defects, such as protein C, protein S, and antithrombin deficiencies, and genetic mutations for FV Leiden, prothrombin gene G20210A (FII G20210A), and methyltetrahydrofolate reductase C677T (MTHFR C677T) were studied. All results were unremarkable except for the unique homozygous FV Leiden mutation, which likely contributed to this prothrombotic situation. This study highlights the fact that FV Leiden may play a significant role in the onset of CVT in young patients.

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BACKGROUND: Hyperhomocysteinaemia has been identified as a strong risk factor for ischemic stroke (IS). A point mutation in methylene tetrahydrofolate reductase (MTHFR C677T) has been associated with increased plasma homocysteine (Hcy) levels. AIM: This preliminary study aimed to investigate whether hyperhomocysteinaemia and/or MTHFR C677T mutation are associated with ischemic stroke. METHODS: A case-control study including 50 consecutive patients with confirmed IS and 97 controls was performed. Fasting plasma homocysteine levels, MTHFR C677T genotypes were assessed. Other factors such as hypertension, obesity, dyslipidemia, diabetes mellitus, recurrent stroke tobacco and alcohol were investigated. RESULTS: Mean plasma homocysteine levels were significantly higher in IS patients than in controls (15.83+/-10.60) µmol/L vs 13.78+/-6.29 µmol/L, p=0.04), while no association of MTHFR C677T variant was observed even with homocysteine. The risk to develop ischemic stroke in hyperhomocysteinemic subjects was 2.4 times more than in subjects with normal Hcy levels (OR= 2.4; 95% CI: 1.13-5.06; p<0.05). CONCLUSION: Our findings suggest that high levels of homocysteine but not MTHFR C677T polymorphism represent risk factors for arterial ischemic stroke in Tunisian subjects.

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