Place des échanges plasmatiques dans la prise en charge des envenimations graves par morsure de vipère : à propos d’un cas avec revue de la littérature.

Les morsures de serpents, qui concernent principalement l’Afrique sub-saharienne et l’Asie du Sud, à l’origine d’une très forte mortalité au Maroc, constituent une urgence médico-chirurgicale préoccupante, surtout en période estivale. La clinique permet de déterminer la gravité de l’envenimation, et de suspecter le type de serpent incriminé, caractérisant un syndrome vipérin. De nombreuses espèces sont retrouvées dans les régions chaudes du Royaume, dont principalement les formes Bitis et Equis. Le syndrome vipérin, associe troubles de l’hémostase et lésions locales (douleur, œdème, nécrose). Les troubles de l’hémostase sont liés à une coagulopathie de consommation induite par le venin (CCIV) à distinguer de la coagulation intravasculaire disséminée et se traduisent le plus souvent par des saignements locaux puis diffus. Les complications locales mettent en jeu essentiellement le pronostic locorégional et fonctionnel du membre atteint. Le sérum antivenimeux, reste la seule thérapeutique logique actuelle des envenimations ophidiennes, mais son cout élevé, son indisponibilité, le risque allergique et la raréfaction des producteurs, limitent de plus en plus son utilisation. L’objectif de notre étude est d’évaluer l’efficacité des échanges plasmatiques devant les envenimations graves par morsure de vipère, à la lumière d’une observation rapportant le cas d’un patient traité par les échanges plasmatiques avec une amélioration clinique et biologique dès la première séance, une durée d’hospitalisation courte, et aucune intervention sur le membre mordu n’a été nécessaire. Plusieurs essais thérapeutiques ont démontré l’efficacité des échanges plasmatiques, leur permettant d’être préconisées comme une mesure thérapeutique prometteuse dans la prise en charge des envenimations graves par morsure de vipère

Brachial Plexus Rupture: A Neglected Trauma, Is There Any Hope?

Teaching point: Magnetic resonance imaging (MRI) has significantly improved the evaluation of brachial plexus injuries, offering new possibilities for microsurgical repair and contributing to the functional prognosis

Incidental optic nerve sheath arachnoid cyst: A rare case finding with literature review

Arachnoid cysts are the most common benign cystic abnormalities formed due to congenital splitting of the arachnoid layer. They comprise 1% of intracranial masses, and the orbital location is even more rarely reported in history especially in the pediatric population. They might be discovered as an asymptomatic finding on imaging performed for a concomitant condition or, in most reported cases, as a result of ophthalmic impairment. They can be isolated or associated with gliomas, neurofibromas, empty sella syndrome, and frontotemporal porencephalic cysts. Computed tomography scan shows a non-enhancing liquid cystic lesion, and magnetic resonance imaging remains the best assessment tool confirming the similarity of the fluid to cerebrospinal fluid and evaluating the optic nerves. Herein, we report the case of an incidental discovery of an intraorbital arachnoid cyst on magnetic resonance imaging in a 53-year-old woman with a history of epilepsy. No treatment was performed as the cystic formation was asymptomatic

Bifocal Intracanial Rosai-Dorfman Disease Mimicking Lymphoplasmacyte-Rich Meningioma: Diagnostic Pitfalls About a Case Report

Rosai-Dorfman disease (RDD) is a clonal histiocytic proliferation characterized by large S100 positive histiocytes with variable emperipolesis. Extranodal locations were confirmed with the central nervous system or the meninges involvement in less than 5% of cases, which is marked as a significant differential diagnosis of meningiomas in radiological and intra-operative pathological examination. Histopathology and immunohistochemistry are the keys to definitive diagnosis. We present a case of bifocal Rosai-Dorfman disease in a 26-year-old man, mimicking Lymphoplasmacyte-rich Meningioma. This case allows us to demonstrate the diagnosis pitfalls encountered in this localization

Septo-optic dysplasia PLUS syndrome in a 23 years old patient: A case report

Septo-optic dysplasia (SOD) is a rare malformation defined by septum pellucidum abnormalities and hypoplasia of the optic nerves and chiasm. It can be associated with cortical development malformations such as schizencephaly, which is then called septo-optic dysplasia plus. It usually manifests at birth, although it may not be diagnosed until childhood, or rarely, adolescence. We report the case of a 23 years old patient, with a history of epilepsy since early childhood never labeled, which was diagnosed with SOD-PLUS with brain MRI in our department

A rare case of Fahr disease revealed by an epileptic seizure

Fahr's disease is a rare neurodegenerative disorder, identified by bilateral and symmetrical intracerebral calcifications of mainly the basal ganglia. Patients often present extrapyramidal or neuropsychological symptoms. Seizure is one of the rarest manifestations that can reveal Fahr disease. We present the case of a 47-year-old male patient who had Fahr disease revealed by an inaugural tonic-clonic seizure

Posterior reversible encephalopathy syndrome (PRES): Should more attention be paid to the atypical forms?

Posterior reversible encephalopathy syndrome (PRES) is an uncommon, but important, pathology affecting primarily the posterior cerebral circulation. Typical imaging features include vasogenic edema involving the bilateral occipital and parietal lobes. We report 4 cases of atypical PRES: The first one is a 59-year-old woman with a medical history of diabetes and hypertension who presented a consciousness disorder. MRI of this patient revealed signal abnormalities in the thalamus, the cerebellum, the brainstem and the corpus callosum with microbleeds and vascularization disorders. The second patient is a 41-year-old woman admitted for right hemiparesis and facial paralysis. Physical examination found a hypertension and the atypical imaging features on MRI were low ADC values with a pearl necklace appearance on ARM sequences. The third patient is a 32-year-old woman who undergone a surgery for an ectopic pregnancy and went in a coma for 8 days. Physical and biological parameters were normal. Diagnosis was delayed because of atypical signal abnormalities in caudal and lentiform nuclei that worsened on follow-up MRI, resulting in a dramatic evolution to bilateral cecity and psychosis. The last case is a 34-year-old woman with terminal renal failure hospitalized for spontaneously resolving tonic-clonic seizures. Biology showed high uremia and brain MRI revealed a gyriform enhancement at gadolinium injection with unilateral putamen lesion. The patient improved after blood purification. Knowledge of these atypical findings can help the radiologist make an accurate, timely diagnosis, and improve patient care