M.R. Maaqili

Chronic subdural haematoma associated with pre-eclampsia: case report and review of the literature.

Pre-eclampsia complicates approximately 5-8% of all pregnancies and may have adverse long-term effects on both mother and child. Chronic atraumatic subdural haematoma as a complication of severe pre-eclampsia, in the absence of clotting factor abnormalities, is a very rare condition. We present the case of a 30-year-old Moroccan woman who had a pregnancy 10 years previously, with an uneventful delivery. She presented with pre-eclampsia complicating a 29-week-old pregnancy. A few days preceding maternity unit admission the patient complained of headaches and malaise. Her blood pressure at admission was 150/120mmHg and subsequently was treated with doses of methyldopa and magnesium sulphate. Her condition worsened with a loss of consciousness 24 hours later and was transferred to the neurosurgical unit. A brain computerized tomography (CT) scan revealed a left-sided subdural haematoma and the patient underwent surgery, with a good postoperative outcome. This article highlights the occurrence of neurological complications due to pre-eclampsia/eclampsia that require particular neurosurgical attention, its treatment and prognosis. We also review the literature regarding this pathology.

Pineal epidermoid cyst: case report and review of the literature

Intracranial epidermoid cysts are one of the rare tumors of all intracranial tumors. They represent 0,2 to 1% of intracranial tumors and 7% of tumors in the cerebellopontine angle. The pineal region is exceptionally subject to such kind of tumor. Cushing was the first to report the pineal localization of the epidermoid cyst in 1928. Up to now, 85 cases of pineal epidermoid cyst were cited in the literature. We report a clinical case concerning a 45 years old man who presented an intracranial hypertension during 18 months. The clinical examination found a hemiparesis with a facial hypoesthesis. The MRI showed a process of the pineal region. The patient underwent a surgery with a large resection. The histological examination confirms the epidermoid cyst. Many approaches were described in the literature. The outcome is related to this localization.

Primary glioblastoma of the cerebellum in a 19-year-old woman: a case report

IntroductionCerebellar glioblastoma is an uncommon adult lesion. The pathogeny and prognosis of cerebellar glioblastoma are still incompletely elucidated.Case presentationWe report the case of a 19-year-old Moroccan woman. A neurologic examination revealed the presence of cerebellar signs. A diagnosis of cerebellar glioblastoma is rarely made before surgery. An encephalic computer tomography scan and magnetic resonance imaging increased the accuracy of defining the nature of the lesion. Magnetic resonance imaging showed a heterogeneously enhancing mass in the vermis and the right cerebellar hemisphere. After surgery, glioblastoma was histologically confirmed. Post-operative radiotherapy followed. The outcome of our patient was favorable after one year of follow-up.ConclusionsWe report an unusual case of cerebellar gliobastoma. Cerebellar glioblastoma multiforme should be considered in the differential diagnosis of a cerebellar mass lesion.

Unusual coexistence of an epidermoid cyst with an atypical meningioma: Case report and review of the literature

Background: Coexistence of multiple primary intracranial tumors of different cell types has rarely been documented; the association of a meningioma and a glioma has been reported as the most common combination. Hereby, we report an unusual case of a temporal epidermoid cyst coexisting with an atypical meningioma. Case Presentation: A 37-year-old male presented with progressive symptoms of raised intracranial progression with progressive loss of vision without any neurological deficit. On admission, magnetic resonance imaging (MRI) revealed a right frontal lesion appearing hypointense T1, hyperintense T2 slightly enhanced after gadolinium and a second right temporal, isointense T1, hyperintense T2 non-enhancing lesion. A right frontotemporal craniotomy was performed that revealed two distinct lesions: The whitish temporal lesion with the pearl appearance reminding of an epidermoid cyst, the second lesion was extraaxial fibrous lesion arising from the falx. Pathology confirmed an atypical meningioma WHO Grade II and an epidermoid cyst. Conclusion: The simultaneous occurrence of primary intracranial tumors of different cell types is rare. Epidermoid cysts are slow growing lesions believed to arise from inclusion of ectodermal elements during neural tube closure, while meningiomas arise from arachnoidal cells; their association has rarely been reported previously.

Tuberculosis of lower cervical spine (C4–C5) with severe angulation

A 28-year-old man presented with 4-month history of neck stiffness associated with progressive deformity of cervical spine and bilateral paresthesia-interested shoulders. There were no histories of falling or fever. On examination, there was a reduced range of movement of the cervical spine without other neurologic deficits. Radiography of cervical spine showed a mark reversal of the cervical spine lordosis, slight drop of C5, important anterior displacement of C4 on C5, and increased posterior interspinous distance (Fig. 1). Chest radiography and thoracoabdominal computed tomography scan were normal. Cervical magnetic resonance imaging (MRI) was performed. Sagittal T2weighted MRI revealed a spinal cord angulations with mild compression associated with thinness of paravertebral soft tissues (Fig. 2, Left). T1-weighted MRI with injection of gadolinium showed enhancement of paravertebral soft tissues and discale involvement (Fig. 2, Right). Biological findings were as follows: C-reactive protein of 12 mg/L,

Méningiome du Foramen Magnum : à propos de 10 cas

lants et de survie chez les patients atteints d’un glioblastome. Les techniques diffèrent entre les centres ainsi que les valeurs seuil utilisées dans l’analyse quantitative par pyroséquençage (seuil de 8 %). Le statut de méthylation n’est pas, à ce jour, un critère intervenant dans la décision thérapeutique. Nous avons évalué la valeur pronostique en terme de survie et la valeur prédictive de réponse au traitement de l’évaluation quantitative de la méthylation du promoteur de MGMT. Le pourcentage de méthylation a été mesuré par pyroséquençage et les données cliniques et histologiques ont été analysées de façon rétrospective sur une population adulte de 159 patients (âge moyen : 60,7 ans) présentant un glioblastome nouvellement diagnostiqué entre 2008 et 2011 et dont l’analyse moléculaire a été réalisée au CHRU de Lille. La valeur moyenne de méthylation de MGMT a été corrélée significativement à une meilleure survie et une meilleure réponse au traitement. Le site 1 de méthylation a été le plus significatif des points de vue prédictif (SSP) et pronostique (SG). La valeur seuil optimale pour départager les patients en termes prédictifs et pronostiques était de 12 %. Néanmoins, une méthylation du site 1 >3 % était déjà significativement un facteur prédictif de bonne réponse au traitement de référence (protocole de Stupp). Une hyperméthylation du site 1 (> 25 %) était un facteur pronostique positif de survie à 2 ans (47 %). L’évaluation quantitative de la méthylation du promoteur de MGMT par pyroséquençage dans la prise en charge du glioblastome permet de préciser les profils évolutifs des patients. La corrélation des données cliniques et techniques permettrait d’abaisser le seuil de positivité et de choisir les sites analysés pour plus de significativité pronostique et prédictive.

Kyste neurentérique intra dural extra médullaire: à propos d’un cas

Le kyste neurenterique (KNE) est une malformation congenitale rare du systeme nerveux central (SNC) entrant dans le cadre des notochordodysraphies. Nous rapportons un nouveau cas de KNE de localisation intra durale extra medullaire chez un patient de 16 ans, admis dans un tableau de compression medullaire cervicale haut evoluant depuis 4 mois. L’imagerie a objective une lesion kystique pre medullaire en regard de C1-C2-C3. Le patient a beneficie d’une evacuation kystique et l’histologie avait conclu a un kyste neurenterique. L’evolution etait marquee par le deces du patient par des complications neurovegetatives graves. Malgre sa benignite histologique, le kyste neurenterique de localisation cervicale haute peut se compliquer de troubles neurovegetatifs parfois imprevisibles pouvant aboutir a une evolution dramatique.

Aspect pseudotumoral d'une tuberculose sacrée

Resume Les auteurs rapportent l’observation d’une femme de 43 ans porteuse d’une tuberculose sacree isolee decouverte a l’occasion d’une impotence fonctionnelle partielle du membre inferieur droit. La rarete de cette localisation osseuse chez une patiente sans antecedents tuberculeux et l’allure veritablement pseudotumorale de la lesion, avec osteolyse diffuse, mal limitee, d’une grande partie de l’os et la volumineuse extension presacree aux parties molles avec refoulement rectal, justifient la presentation de cette observation.