Papers by Asmell R A M O S Cabrera
Medicine & Clinical Science, 2024
Cerebral venous sinus thrombosis (CVST) is a rare and potentially fatal condition, accounting for... more Cerebral venous sinus thrombosis (CVST) is a rare and potentially fatal condition, accounting for about
0.5% of all cerebrovascular disease cases globally. It is challenging to diagnose due to its rarity and
diverse clinical presentations that can mimic other acute neurological conditions [1]. The reported
worldwide incidence of CVST during pregnancy and postpartum is approximately 3 to 4 cases per
million, with superior sagittal sinus thrombosis (SSST) being the most prevalent type. Risk factors
include the prothrombotic state of pregnancy in the third trimester, obesity, accidental dural puncture,
deficiencies in protein C and S, antiphospholipid syndrome, and the use of oral contraceptives among
others. Symptoms typically manifest within the first three weeks postpartum, with severe headache
being the most common complaint. The low number of reported cases in sub-Saharan Africa suggests
underdiagnosing or underreporting, with infection being the primary cause in this region. We report a
case at our facility who, two weeks after a cesarean section, presented with severe headache, confusion,
irritability, restlessness, and later developed a focal motor deficit. Imaging studies were crucial in
diagnosing SSST and ruling out other conditions causing acute brain injury. This is the first reported
case in The Gambia, and one of the few described in West Africa related to an obstetric procedure. The
onset, characterized by neuropsychiatric symptoms, is unusual and interesting, as these manifestations
are less common than the typical headache, seizure, and focal motor deficit described in the literature.
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Med Clin Sci. , 0
Locked-in syndrome (LIS) is well known to the public, since the masterful description of Alexandr... more Locked-in syndrome (LIS) is well known to the public, since the masterful description of Alexandre
Dumas. Additionally, Émile Zola reflected this condition in one of his characters, and later, others
did as well [1]. In medical practice it is considered a rare neurological disease, with an incidence
and a prevalence that is difficult to determine. It affects both sexes and is more common in adults,
basically, as a complication of cerebrovascular diseases (CVD). Patients with classic LIS develop
quadriplegia, but normally remain conscious and can communicate by blinking, constituting the most
dramatic presentation of brain stem involvement. To diagnose it is challenging because of its similarity
to conditions such as akinetic mutism, coma, persistent vegetative state, psychogenic pseudocoma,
or brain death. There have been cases reported that have taken months and even years to establish a
definitive diagnosis. The CVD incidence rate in Africa is among the highest incidence in the world,
with West Africa (WA) being the largest. Paradoxically, no reports of LIS associated with CVD have
been found in the subregion. Our goal is to document the first case in WA of a patient with classic-type
locked-in syndrome, secondary to acute pontine ischemic infarction, associated to severe vitamin B
deficiency, and accompanying by acute osmotic demyelination syndrome. Which was a result of the
intensive correction of severe hyponatremia. A case that is difficult to manage and complex to diagnose,
which makes it especially interesting for our professionals. Recognizing the disease will avoid delays
in diagnosis and facilitate early intervention, reducing associated complications and mortality, which
remains high in the initial phases. Then, together with a multidisciplinary team, achieve the best possible
social reintegration of patients, knowing in advance the serious limitations they will face in their future.
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Medicine & Clinical Science, 2023
The first report of intermittent hydrarthrosis (IH) was made by Perrin in 1845; However, despite ... more The first report of intermittent hydrarthrosis (IH) was made by Perrin in 1845; However, despite the simplicity of the symptoms and signs that characterize it, it is considered a rare disease, presumably its pathophysiology is autoinflammatory and of uncertain etiology. According to the number of reports published to date, the description of new cases remains extremely low. The chronicity and periodicity of the attacks of joint swelling, the tropism for the affected joint, almost always the knee, as well as the complete recovery without sequela after each attack, constitutes its characteristic hallmark. The simplicity of the clinical picture is at the same time the greatest obstacle to establishing the definitive diagnosis. Considering that there are no diagnostic criteria, it is necessary to exclude all conditions with a similar pattern, making the list large and complex. During the review of the literature, no references of publications of black patients were found, nor reports on the African continent. We decided to present the first case of intermittent hydrarthrosis in The Gambia and to date in the entire subregion.
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Medicine & Clinical Science, 2023
Chronic inflammatory bowel disease is characterized by a plethora of intestinal and extra-intesti... more Chronic inflammatory bowel disease is characterized by a plethora of intestinal and extra-intestinal manifestations, and it is not difficult to establish its diagnosis when all the elements are present; however, when the extra-intestinal manifestations precede and are more severe than the intestinal symptoms themselves, then it becomes a diagnostic challenge, delaying treatment, affecting quality of life, and darkening its prognosis. We report a case with six-months onset of necrotic ulcerative lesions, compatible with severe pyoderma gangrenosum, as the first and only manifestation of the disease during first four months, with only and vague symptoms of intestinal manifestations such as abdominal pain, and diarrhea with phlegm and rarely with blood last two months. Diagnosis of ulcerative colitis was established through colonoscopy, with the biopsy being non-specific in the diagnosis of colitis. The response of the dermatological manifestations was spectacular to conventional therapy with steroids and salicylates.
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International Journal of Medical Science and clinical research studies , 2022
Behcet's disease (BD) is a rare condition, considered as a variable vessel vasculitis with multis... more Behcet's disease (BD) is a rare condition, considered as a variable vessel vasculitis with multisystem involvement, characterized by the triad of recurrent mouth and genital ulcers with eye involvement, also may involve joints, skin, central nervous system, and gastrointestinal tract with important heterogeneity among patients regarding demographic features and organ manifestations. BD has a worldwide distribution. However, it is observed commonly among populations living along the historic Silk Road.The etiology of the disease remains unknown, but the most widely held hypothesis of disease pathogenesis is that of a profound inflammatory response triggered by an infectious agent in a genetically susceptible host. Number of reported cases is inexplicably low in sub-Saharan region and especially lowest in West Africa where only few cases have been reported. The aim of this presentation is to announce the first case description of BD in Gambia as well as, to sensitize physicians, Internal Medicine residents and general practitioners in our sub region with the pattern of the disease, as only way to reduce the diagnosis time frame.
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Academia Letters, 2022
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Drafts by Asmell R A M O S Cabrera
Post Malaria neurological syndrome: unknown, underestimated, or underdiagnosed? First report done in Gambia., 2022
Post-malaria neurological syndrome (PMNS) is a rare self-limiting neurological complication that ... more Post-malaria neurological syndrome (PMNS) is a rare self-limiting neurological complication that can occur after recovery from malaria, usually severe falciparum malaria. It is characterized by a myriad of neuropsychiatric manifestations including mild neurological deficit to severe encephalopathy [1]. PMNS is a debated entity, is a rare complication of severe malaria that might be underreported. It can develop up to 2 months after clearance of parasitemia. Clinical features can be variable. Most cases are self-limited, but more severe cases may benefit from steroid therapy. There are several neurological syndromes that can occur following complete recovery from malaria, in particular Plasmodium falciparum. These PMNS include, delayed cerebellar ataxia (DCA), acute inflammatory demyelinating polyneuropathy (AIDP) and acute disseminated encephalomyelitis (ADEM) [2]. In 2021 according to WHO report, the African region was home to 95% of all malaria cases and 96% of deaths [3]. Paradoxically, reports of post malaria neurological syndrome in west Africa sub region are practically null, it is not clear if it is due to lack of knowledge regarding the disease, underdiagnosis or combination of factors, the first case of post malaria neurological syndrome in Gambia is described below. The objective is to show that cases exist, but due to lack of knowledge by health personnel they are overwhelmingly underdiagnosed.
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Recurrent oral and scrotal inflammatory lesions in a young man: First case report of Behcet’s disease in Gambia., 2022
Behcet's disease (BD) is a rare condition, considered as a variable vessel vasculitis with multi-... more Behcet's disease (BD) is a rare condition, considered as a variable vessel vasculitis with multi-system involvement, characterized by the triad of recurrent mouth and genital ulcers with eye involvement, also may involve joints, skin, central nervous system, and gastrointestinal tract with important heterogeneity among patients regarding demographic features and organ manifestations. BD has a worldwide distribution. However, it is observed commonly among populations living along the historic Silk Road.The etiology of the disease remains unknown, but the most widely held hypothesis of disease pathogenesis is that of a profound inflammatory response triggered by an infectious agent in a genetically susceptible host. Number of reported cases is inexplicably low in sub-Saharan region and especially lowest in West Africa where only few cases have been reported. The aim of this presentation is to announce the first case description of BD in Gambia as well as, to sensitize physicians, Internal Medicine residents and general practitioners in our sub region with the pattern of the disease, as only way to reduce the diagnosis time frame.
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Papers by Asmell R A M O S Cabrera
0.5% of all cerebrovascular disease cases globally. It is challenging to diagnose due to its rarity and
diverse clinical presentations that can mimic other acute neurological conditions [1]. The reported
worldwide incidence of CVST during pregnancy and postpartum is approximately 3 to 4 cases per
million, with superior sagittal sinus thrombosis (SSST) being the most prevalent type. Risk factors
include the prothrombotic state of pregnancy in the third trimester, obesity, accidental dural puncture,
deficiencies in protein C and S, antiphospholipid syndrome, and the use of oral contraceptives among
others. Symptoms typically manifest within the first three weeks postpartum, with severe headache
being the most common complaint. The low number of reported cases in sub-Saharan Africa suggests
underdiagnosing or underreporting, with infection being the primary cause in this region. We report a
case at our facility who, two weeks after a cesarean section, presented with severe headache, confusion,
irritability, restlessness, and later developed a focal motor deficit. Imaging studies were crucial in
diagnosing SSST and ruling out other conditions causing acute brain injury. This is the first reported
case in The Gambia, and one of the few described in West Africa related to an obstetric procedure. The
onset, characterized by neuropsychiatric symptoms, is unusual and interesting, as these manifestations
are less common than the typical headache, seizure, and focal motor deficit described in the literature.
Dumas. Additionally, Émile Zola reflected this condition in one of his characters, and later, others
did as well [1]. In medical practice it is considered a rare neurological disease, with an incidence
and a prevalence that is difficult to determine. It affects both sexes and is more common in adults,
basically, as a complication of cerebrovascular diseases (CVD). Patients with classic LIS develop
quadriplegia, but normally remain conscious and can communicate by blinking, constituting the most
dramatic presentation of brain stem involvement. To diagnose it is challenging because of its similarity
to conditions such as akinetic mutism, coma, persistent vegetative state, psychogenic pseudocoma,
or brain death. There have been cases reported that have taken months and even years to establish a
definitive diagnosis. The CVD incidence rate in Africa is among the highest incidence in the world,
with West Africa (WA) being the largest. Paradoxically, no reports of LIS associated with CVD have
been found in the subregion. Our goal is to document the first case in WA of a patient with classic-type
locked-in syndrome, secondary to acute pontine ischemic infarction, associated to severe vitamin B
deficiency, and accompanying by acute osmotic demyelination syndrome. Which was a result of the
intensive correction of severe hyponatremia. A case that is difficult to manage and complex to diagnose,
which makes it especially interesting for our professionals. Recognizing the disease will avoid delays
in diagnosis and facilitate early intervention, reducing associated complications and mortality, which
remains high in the initial phases. Then, together with a multidisciplinary team, achieve the best possible
social reintegration of patients, knowing in advance the serious limitations they will face in their future.
Drafts by Asmell R A M O S Cabrera
0.5% of all cerebrovascular disease cases globally. It is challenging to diagnose due to its rarity and
diverse clinical presentations that can mimic other acute neurological conditions [1]. The reported
worldwide incidence of CVST during pregnancy and postpartum is approximately 3 to 4 cases per
million, with superior sagittal sinus thrombosis (SSST) being the most prevalent type. Risk factors
include the prothrombotic state of pregnancy in the third trimester, obesity, accidental dural puncture,
deficiencies in protein C and S, antiphospholipid syndrome, and the use of oral contraceptives among
others. Symptoms typically manifest within the first three weeks postpartum, with severe headache
being the most common complaint. The low number of reported cases in sub-Saharan Africa suggests
underdiagnosing or underreporting, with infection being the primary cause in this region. We report a
case at our facility who, two weeks after a cesarean section, presented with severe headache, confusion,
irritability, restlessness, and later developed a focal motor deficit. Imaging studies were crucial in
diagnosing SSST and ruling out other conditions causing acute brain injury. This is the first reported
case in The Gambia, and one of the few described in West Africa related to an obstetric procedure. The
onset, characterized by neuropsychiatric symptoms, is unusual and interesting, as these manifestations
are less common than the typical headache, seizure, and focal motor deficit described in the literature.
Dumas. Additionally, Émile Zola reflected this condition in one of his characters, and later, others
did as well [1]. In medical practice it is considered a rare neurological disease, with an incidence
and a prevalence that is difficult to determine. It affects both sexes and is more common in adults,
basically, as a complication of cerebrovascular diseases (CVD). Patients with classic LIS develop
quadriplegia, but normally remain conscious and can communicate by blinking, constituting the most
dramatic presentation of brain stem involvement. To diagnose it is challenging because of its similarity
to conditions such as akinetic mutism, coma, persistent vegetative state, psychogenic pseudocoma,
or brain death. There have been cases reported that have taken months and even years to establish a
definitive diagnosis. The CVD incidence rate in Africa is among the highest incidence in the world,
with West Africa (WA) being the largest. Paradoxically, no reports of LIS associated with CVD have
been found in the subregion. Our goal is to document the first case in WA of a patient with classic-type
locked-in syndrome, secondary to acute pontine ischemic infarction, associated to severe vitamin B
deficiency, and accompanying by acute osmotic demyelination syndrome. Which was a result of the
intensive correction of severe hyponatremia. A case that is difficult to manage and complex to diagnose,
which makes it especially interesting for our professionals. Recognizing the disease will avoid delays
in diagnosis and facilitate early intervention, reducing associated complications and mortality, which
remains high in the initial phases. Then, together with a multidisciplinary team, achieve the best possible
social reintegration of patients, knowing in advance the serious limitations they will face in their future.