Sami Kouki

Postpartum spontaneous pneumomediastinum 'Hamman's syndrome'

Spontaneous pneumomediastinum and subcutaneous emphysema (Hammans syndrome) are rare but potentially dangerous complications of labour. The authors reported a case of a 23-year-old primigravida, admitted to our hospital for delivery after 40 weeks of pregnancy. She delivered a baby of 4.27 kg after 9 h from the start of labour. A few minutes after delivery, the patient developed dyspnoea and chest tightness, which made her doctor suspect pulmonary embolism. A chest X-ray and CT scan revealed pneumomediastinum and subcutaneous emphysema. The patient had been followed up for 3 days in our hospital, without specific therapy.

Eagle's syndrome presenting as a cervical mass

We report a case of an 84-year-old man who had completely recovered from Hodgkins disease and was consulting, after 2 years, for severe odynophagia. Clinical examination showed a left cervical mass associated with a bilateral filling tonsillar fossa. A relapse with a cervical compressive lymph node was suspected. An elongated styloid process, particularly on the left side, was identified on a CT scan. Multiplanar reconstructions (figure 1), volume rendering (figure 2) and …

Keys for reporting an fMRI in motor control study

an olfactory discrimination test is performed. During the juvenile period, behavioral tests assessing exploration (Open field at P15, 20, 25), sensorimotor gating (Prepulse inhibition (PPI) at P35), and social interactions assessments (at P40) were used to detect behavioral impairments. Brains were removed at P40 for neuropathological studies (MRI, immunohistochemical studies and electron microscopy studies). Results: Brain damage featured lateral ventricles widening, predominately in male, reduction of periventricular external capsules thickness, oligodendrocyte loss, and disorganization of fronto-parietal sub-cortical tissue without any persistant glial proliferation. Autistic hallmarks were found in offspring exposed to GBS, namely deficits in exploratory behavior, social and communicative impairments, i.e. profound defects in the integration and response to both acoustic (PPI) and chemical signals (nest-seeking test) that are predominant modes of communication in rats. Surprisingly, only male offspring were affected by these combined autistic-like traits. Discussion: Our results show for the first time that maternofetal inflammatory response to GBS plays a role in the induction of cerebral insults, remarkably recapitulating cardinal features of human autism, such as gender dichotomy and neurobehavioral traits. These results also provide important evidence that beyond genetic influences, modifiable environmental factors play a role in both the occurrence of autism, and in its gender imbalance.

AB0708 Neuropsychiatric manifestations in systemic lupus erythematosus: About 80 tunisian patients

Background Systemic lupus erythematosus (SLE) is a relapsing-remitting autoimmune disease. The frequency of neuropsychiatric manifestations in SLE studies varies widely, depending on the type of manifestations included and the methods used for evaluation. Neuropsychiatric (NP) manifestations may be considered primary if directly related to SLE activity, or secondary when related to treatment, infections, metabolic abnormalities or other systemic manifestations such as uremia and hypertension. Objectives To evaluate the prevalence and characteristics of different neurological and psychiatric presentations in patients admitted to the department of Internal Medicine of the Military Hospital of Tunis hospital with systemic lupus erythematosus (SLE). Methods In this retrospective hospital-based study, we examined the medical records of 80 patients with SLE from 2000 to 2010 in our department. All patients fulfilled the criteria of the American College of Rheumatology (ACR). Results Eighteen (80) SLE patients were included in the study. The prevalence of neuropsychiatric syndromes in our study was estimated to be 27% and the most frequent NP syndromes were headaches (28%), seizures (27%) and cognitive dysfunctions (21%). Meningitis, convulsions and cerebrovascular events were found respectively in: 16 cases (21%), 11 cases (16%) and 6 cases (7%). One patient had an optic neuropathy and onether extrapyramidal syndrome. No cases of plexopathy or Guillain-Barré syndrome were reported. MRI abnormalities were found in 21 cases (27%).Glucocorticoids and immunosuppressive therapy were indicated when NP manifestations were thought to reflect an inflammatory process in SLE(optic neuritis, refractory seizures, psychosis) and in the presence of generalized lupus activity. Antiplatelet and anticoagulation therapy were indicated when manifestations are related to antiphospholipid syndrome. Conclusions The prevalence and nature of different neurological presentations of SLE in Tunisian patients has some similarities to that reported in the literature. Differences are due to ethnic and environmental factors References Jennekens FG, Kater L. The central nervous system in systemic lupus erythematosus Part 1: Clinical syndromes: A literature investigation. Rheumatology 2002;41:605-18. [PUBMED] [FULLTEXT] Weiner SM, Peter NH. Neuropsychiatric involvement in systemic lupus erythematosus: Part 1: Clinical presentation and pathogenesis. Med Klin (Munich) 2002;97:730-7. Futrell N, Schultz LR, Millikan C. Central nervous system disease in patients with systemic lupus erythematosus. Neurology 1992;42:1649-57. Disclosure of Interest None Declared

NR-WP-58 Imagerie des compressions medullaires d’origine tumorale

Objectifs pedagogiques Connaitre les differentes etiologies des compressions medullaires d’origine tumorale. Connaitre leurs aspects a l’IRM (imagerie par resonance magnetique). Savoir les elements du diagnostic differentiel. Messages a retenir La compression medullaire est une urgence medicochirugicale. Le diagnostic positif est clinique. Le diagnostic du siege et de la cause repose sur l’imagerie. L’IRM est l’examen de base pour l’etude du contenu du canal rachidien permettant ainsi une caracterisation tumorale et une approche etiologique. Les etiologies sont dominees par les causes extradurales en particulier malignes secondaires.