Miloudi Gazzaz

Sudden onset of paraplegia caused by hemorrhagic spinal epidural angiolipoma. A case report

Spinal epidural angiolipoma is a rare benign tumor containing vascular and mature adipose elements. A slow progressive clinical course was mostly presented and rarely a fluctuating course during pregnancy. The authors report the original case of spontaneous spinal epidural bleeding resulting from thoracic epidural angiolipoma who presented with hyperacute onset of paraplegia, simulating an extradural hematoma. The patient was admitted with sudden non-traumatic hyperacute paraplegia during a prolonged walk. Neurologic examination showed sensory loss below T6 and bladder disturbances. Spinal MRI revealed a non-enhanced heterogeneous thoracic epidural lesion, extending from T2 to T3. A bilateral T2–T4 laminectomy was performed to achieve resection of a lipomatous tumor containing area of spontaneous hemorrhage. The postoperative course was uneventful with complete neurologic recovery. Histologic examination revealed the tumor as an angiolipoma. Because the prognosis after rapid surgical management of this lesion is favorable, the diagnosis of spinal angiolipoma with bleeding should be considered in the differential diagnosis of hyperacute spinal cord compression.

Cavernous hemangioma of the skull: 3 case reports

BACKGROUND Intraosseous cavernous hemangiomas of the bone are uncommon tumors, accounting for 0.7% to 1% of all bone neoplasms. The vertebral column is most often affected, followed by the skull. Calvarial cavernous hemangioma is rare, comprising about 0.2% of all benign neoplasms of the skull. CASES REPORTS We describe 3 patients with calvarial hemangiomas that were localized frontally (2 cases) and parietally. The diameter ranged from 2 to 3 cm. They presented with slowly growing mass, hard to pressure, with freely mobile skin above the cavernoma sites. Cranial CT scan showed osteolytic lesion with erosion of the tabula externa. Magnetic resonance imaging performed in one patient showed hypointense lesion on T1-weighted image and hyperintense on T2-weighted image. Resection and postoperative course were uneventful. Pathological examination revealed a cavernous hemangioma of the diploe. CONCLUSION Skull cavernous hemangiomas are rare benign tumors. The preferred treatment is complete tumor removal with normal bony margins. Sometimes, the classic radiographic appearances are not evident. Consequently, the diagnosis is most often made during surgical resection.

Posterior epidural migration of lumbar disk fragments: report of two cases and review of the literature

BACKGROUND Posterior epidural migration of an extruded disk fragment is rare, and posterior migration of the free fragments causing cauda equina syndrome is exceptionally rare. The disk fragment must transgress through numerous anatomical restraints including the nerve roots in such cases. METHODS Two cases of migration of the sequestrated disk into the posterior epidural space are presented. The first patient complained, over the course of 1 month, of paresthesias and weakness of the lower limbs, with urinary retention. However, in the other case, there was steppage gait and strength score of 3/5 on dorsiflexion of left foot, without bladder or bowel disturbance. RESULTS Lumbar CT scan with sagittal reconstruction showed a posterior epidural mass, which was isodense to the disk. The preoperative differential diagnosis included epidural abscess, hematoma, and neoplasm. An urgent decompressive lumbar laminectomy was performed. At surgery, the lesion proved to be a massive extruded disk fragment. CONCLUSION Diagnosis of posterior epidural migration of the sequestrated disks may be difficult. It may present with subtle clinical features. Magnetic resonance images may mimic those of other more common posterior epidural lesions. Early surgery should be the first choice to prevent severe neurologic deficits.

Thoracic spinal cord compression by ligamentum flavum ossifications

Ossification of the ligamentum flavum is common in Japan but rare in Western countries. Myelopathy of variable severity is a possible complication. Extension of the lesions over several levels at the thoracic spine is exceedingly rare. We report a new case in a 50-year-old man who had slowly progressive spinal cord compression with a sensory level at the navel. Computed tomography (CT) and magnetic resonance imaging (MRI) of the thoracic spine showed calcium-density masses that were in contact with the neural arches and bulged into the spinal canal at T5/T6, T7/T8, T9/T10, and T10/T11. Laboratory test findings were unremarkable. Surgical decompression by laminectomy and foraminotomy was followed by a favorable outcome. Histology showed extensive areas of bone metaplasia associated with calcific deposits. The diagnosis, treatment, and possible etiologies of this rare condition are discussed based on a literature review.

Factors Influencing the Prognosis in Intracranial Dural Arteriovenous Fistulas with Perimedullary Drainage

OBJECTIVE Intracranial dural arteriovenous fistulas with perimedullary venous drainage (IDAVFPD) are classified as type V dural arteriovenous fistulas. Publications are limited to single case reports and small case series. We conducted a systematic review of the literature for patients with IDAVFPD. The aim of this study is to identify the predictive factors of poor prognosis in patients with IDAVFPD. METHODS We present the case of a 48-year-old man who underwent surgical interruption of IDAVFPD. A complete MEDLINE search was then undertaken for all articles reporting outcomes data for IDAVFPD. According to the results we have divided the patient population into two groups: I, those patients who showed improvement after treatment, and II: those patients who did not show improvement. We conducted a comparative statistical analysis of the epidemiologic, clinical, radiologic, and therapeutic parameters between the two groups. RESULTS A total of 37 articles comprising with 58 cases were included for analysis with an average follow-up of 12 months. There were 36 patients in group I and 22 in group II. The average age was 57.8 years in group I and 54.3 years in group II (P=0.32). Onset of symptoms was acute or subacute in 57% of patients in group I, and in 50% of patients in group II (P=0.62). Bulbar signs were present in 28% of cases in group I and in 36% of cases in group II (P=0.49). Hyperintensity of the brainstem on T2-weighted sequence magnetic resonance imaging was more common in patients in group II (78%) compared with patients in group I (45%) (P=0.012). Patients who underwent surgical procedure have shown good outcomes compared to patients treated with endovascular approach (P=0.039). CONCLUSIONS The poor outcomes were correlated to the presence of brainstem signal abnormalities on magnetic resonance imaging, whereas the prognosis does not depend on age, sex, clinical presentation, or anatomic characteristics of the fistula.

Benign fronto-orbital osteoblastoma arising from the orbital roof: case report and literature review

BACKGROUND Osteoblastoma is an uncommon benign osteogenic neoplasm that rarely involves the orbit. Intracranial and intraorbital extension causing neurologic and ophthalmologic symptoms and signs is very unusual. We report the case of an osteoblastoma of the orbital cavity with ethmoidal and anterior cranial fossa extension presenting as unilateral proptosis. Manifestations and management of this rare fronto-orbital lesion are discussed, and the relevant literature is reviewed. CASE DESCRIPTION This 22-year-old man experienced a 3-month history of progressive left proptosis without neurologic symptoms. Computed tomography and magnetic resonance imaging scans demonstrated a bony mass involving the roof of the left orbit and extending laterally to the adjacent ethmoid cells and upward to the lower part of the homolateral frontal convexity without parenchymal abnormality. A presumptive diagnosis of osteoma was considered. A left fronto-orbital craniotomy was performed. At surgery, the tumor was well circumscribed by a sclerotic margin. It was granular with bony spicules, destroying the orbital roof and involving the orbital cavity, ethmoidal cells, and anterior cranial fossa. The lesion was totally removed, and the anterior cranial base reconstructed. The histologic features were typical of benign osteoblastoma. After a follow-up period of 12 months, the patient has remained well without evidence of recurrence. CONCLUSION Osteoblastoma should be considered in the differential diagnosis with other fronto-orbital bone-forming lesions. Although generally regarded as benign, a complete resection is recommended to prevent the possibility of postoperative recurrence and malignant transformation. Twelve previously reported cases were also reviewed.

Chondrosarcome mésenchymateux sphéno-orbitaire : À propos d'un cas

Mesenchymal chondrosarcoma is a highly malignant and extremely rare tumor of the orbit: only 18 cases have been reported to date. We report a case of spheno-orbital mesenchymal chondrosarcoma in a 36-year-old woman presented with a 4-month history of progressive left exophthalmia and temporal mass. A CT-scan of the orbit and MRI showed a spheno-orbital mass, with temporal fossa extension, fed by the internal maxillary artery visible on cerebral angiography. Surgery via a transcranial, left frontotemporozygomatic approach after selective embolization enabled subtotal removal. Definitive histologic examination revealed mesenchymal chondrosarcoma. Postoperatively, exophthalmia spectacularly regressed. We report our clinical findings and present a review of the literature.Le chondrosarcome mesenchymateux spheno-orbitaire est une tumeur extremement rare a haute malignite. Seuls 18 cas ont ete rapportes a ce jour. Nous rapportons le cas d’un chondrosarcome mesenchymateux spheno-orbitaire chez une patiente âgee de 36 ans ayant presente une exophtalmie gauche avec une tumefaction temporale gauche evoluant depuis 4 mois. La tomodensitometrie de l’orbite et l’IRM encephalique montraient un processus spheno-orbitaire avec une extension vers la fosse temporale. Ce processus etait alimente essentiellement par l’artere maxillaire interne a l’arteriographie cerebrale. Un abord chirurgical par voie fronto-temporo-zygomatique gauche avec une depose du rebord orbitaire lateral apres embolisation selective de la tumeur permit une exerese subtotale de la tumeur. L’examen histologique conclut a un chondrosarcome mesenchymateux. L’evolution fut favorable avec une reduction spectaculaire de l’exophtalmie gauche.

Arachnoiditis ossificans of the cauda equina

Abstract A case of post-traumatic arachnoiditis ossificans of the cauda equina is reported. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equine compression. The pathophysiology and therapeutic strategy of this rare entity are still controversial.

Multiple lytic lesions of the spine: a rare diagnosis of eosinophilic granuloma in an adult: a case report

Eosinophilic granuloma (EG) is a rare benign osteolytic lesion observed rarely in adults, with only some 18 cases of spinal location reported in the literature. We present an unusual variant of EG in a 23-year-old man with radiological features of multiple spinal lytic lesions which was evocated of metastatic processes. A surgically transpedicular biopsy of the thoracic collapsed vertebrae with posterior stabilization was made. Histological examination of the tissue showed features of eosinophilic granuloma. The clinical and radiological findings of EG present dilemmas of both diagnosis and treatment. The etiology is unclear and the therapeutic approach is still controversial.

Hypocalcemic seizure in adult: rare cause of lumbar fracture.

Bone fractures in epileptic patients may be associated with rauma either induced directly by a seizure or resulting from a fall or ther accident resulting from the seizure [1]. Muscular contractions enerated during a seizure can lead to a variety of musculoskeletal njuries as fractures and dislocations of the shoulder, femur, and cetabulum [2]. A seizure-induced fracture of the spine is a rare linical entity with only few reported cases in the medical literature o date [1,3]. Although rare, it is extremely crucial to recognize this mergent fracture because it predisposes the patient to irreversible eurological injury [4].