Multiple Sclerosis in a Chronic Smoker: A Case and Literature Review at the National General Referral Hospital of N’Djamena (Chad)

Introduction: Multiple sclerosis is characterized by demyelination of the white matter of the central nervous system. Multiple sclerosis (MS) manifests clinically by subacute encephalic and/or medullary pictures. In black Africa; a few cases have been reported in Senegal, Kenya and Ivory Coast. In Chad, no study has been carried out to date on Multiple sclerosis (MS). Observation: Mr. AX, 35 years old, a trader with a history of chronic smoking, was admitted on March 13, 2023, for progressive left hemiplegia. The clinical picture began a few days earlier with paresthesias of the right upper limb. These sensory disturbances were followed by rapidly progressive left hemiplegia. She also reported recent blurred vision. The brain scan was strictly normal. During hospitalization, she presented with monoplegia of the right upper limb. Treatment with methylprednisolone at a rate of 1 g of solumedrol in 500 ml of glucose serum was instituted once a day for 5 days. The patient was then urgently evacuated to Senegal. A cerebral and spinal cord resonance imaging (MRI) was performed. It showed several hypersignals at the cerebral level, suggesting Multiple sclerosis (MS). At the medullary level: confluent hyper signals of the MS type. Discussion: MS is considered rare in Africa, particularly in Central Africa. Several factors tend to explain this: The existence of a North-South gradient: in fact, the further one moves away from the equator, the more the prevalence of the condition tends to increase, while it is low in neighboring regions; in tropical and intertropical countries, the prevalence of MS varies between 5.0 and 6.5/100,000 inhabitants. Recent studies, notably those of 2021 and 2024, confirm this link. It has been shown that smoking increases the risk of developing Multiple sclerosis (MS). And that passive smoking can also have an impact, particularly in children. In addition, smoking appears to worsen the course of the disease in people already suffering from MS, increasing the risk of progression to more severe forms and accelerating the occurrence of flare-ups. Smokers have a higher risk of developing MS than non-smokers. The more a person smokes and the longer they smoke, the greater their risk. In people with MS, smoking is linked to faster disease progression and an increased risk of more severe forms. Conclusion: MS, although rare in Central Africa, is evolving from its status as a myth to become a reality with the advent of MRI in our medical practice. Chad has a diversity The ethnicity of its population and its geographical location may constitute an interesting field for the study of this condition. The accessibility of beta interferon at a lower cost will be the major future challenge in the management of MS in our country.