L. Essaadouni

A migraine as initial presentation of celiac disease

Celiac disease (CD), also known as gluten-sensitive enteropathy, is a prevalent auto-immune disorder. The silent form of CD seems to be more frequent than expected. CD has been associated with neurologic and psychiatric disorders, notably cerebellar ataxia, peripheral neuropathy, epilepsy, dementia and depression. Migraine is a rare complication of CD. We report a case of CD revealed by a migraine. Apparently no case of celiac disease revealed by migraine has been reported in the literature.

Coexistence of renal artery stenosis, primary antiphospholipid syndrome and polycythaemia vera: an exceptional association.

Renal artery stenosis is the narrowing of the renal artery which causes hypertension and atrophy of the affected kidney, ultimately leading to renal failure if not treated and most often caused by atherosclerosis or fibromuscular dysplasia. Recently, renal artery stenosis has also been documented in patients with the antiphospholipid syndrome and in very few cases with myeloproliferative disease. In this paper, we describe a 31-year-old female with a history of gangrene affecting the toes with severe hypertension (200/110 mmHg), whose investigations revealed a combination of renal artery stenosis, primary antiphospholipid syndrome and polycythaemia vera.

Intracranial aneurysm revealing a HIV infection and resolving with highly active antiretroviral therapy

These lesions are commonly seen in children and young adults, with no gender difference.[5] The exact pathogenesis is unclear, but it could be due to a trapped adipocyte during embryogenesis, during the neural tube formation stage. This is thus a hamartoma rather than a true neoplasm.[6] These are slow growing tumors, which cause progressive symptoms over the years. The clinical presentation is usually a long duration of nonspecific symptoms, which then progress to numbness, altered gait, spasticity of the limbs and bowel or bladder disturbances. MRI remains the best investigation, not only for a diagnosis, but also for knowing the extent of the lesion and its relation with the cord.[7] Microsurgical excision with or without duroplasty is the treatment of choice. Surgery, however, may be limited by the adherence of the lipoma to the cord, due to the encapsulated nerve roots, and hence, subtotal excision with regular follow-up is the best option. Figure 3: Postoperative MRI showing near total excision with expanded spinal cord and remnants of lipoma at the superior and inferior margins Figure 2: H and E stain showing lobules of mature adipose tissue (lipoma) Yam B. Roka, M. Shrestha1, P. R. Puri, Hari B. Adhikari Departments of Neurosurgery, and 1Anesthesiology, Neuro Hospital, Jahada Road, Biratnagar-13, Nepal E-mail: dryamroka@yahoo.com

Sacral pain as the initial symptom in primary Hodgkin's lymphoma of bone.

Progressive painless enlargement of peripheral lymph nodes is the most common presentation of Hodgkins lymphoma. The bone involvement is seen particularly in the later stages, but very rarely in early stages of the disease. Primary osseous Hodgkin lymphoma is exceedingly rare. Here, we report a case of Primary osseous Hodgkin lymphoma in a 35-year-old male presenting with osteolytic lesions of iliac and sacral bone without other symptoms. Histopathology examination revealed Hodgkins disease. All other investigations (including computed tomography of the chest, abdomen and pelvis, bone marrow aspiration) were negative for occult disease. Polychemotherapy was started and the symptoms resolved. The case report highlights the importance of clinical suspicion of primary Hodgkin lymphoma of the bone, especially those involving the pelvis bones.

Une céphalée migraineuse révélant une maladie cœliaque : à propos d’un cas

u stade de cirrhose au moment du diagnostic. Des manifestaions auto-immunes associées ont été retrouvées chez 23 patients 71,87 %) et étaient dominées par la thyroïdite auto-immune et e syndrome de Goujerot-Sjogren. Un syndrome de chevaucheent a été retenu dans 17 cas (50 %), associant Cirrhose biliaire rimitive-HAI (46,8 %) ou cholangite sclérosante primitive-HAI 6,25 %). Vingt patients ont été traités. Le traitement a consisté ans tous les cas en l’association corticoïdes-azathioprime. La émission complète a été obtenue chez 19 patients (95 %). Dix our cent des sujets ont récidivé après un délai moyen de 2 mois. Une décompensation œdémato-ascitique de la cirrhose st survenue chez 3 patients présentant tous un syndrome de hevauchement. onclusion.– En Tunisie, le profil épidémiologique et clinique des alades atteints d’une HAI est similaire à celui rapporté dans la ittérature mais avec un taux plus élevé de cirrhose au moment du iagnostic.