Une cause rare de recidive de lombosciatalgie

Le terme de textile est un terme non médical qui désigne un objet synthétique oublié dans le foyer opératoire ainsi que la réaction inflammatoire qui l’entoure. Cette complication bien qu’elle soit connue est rarement publiée à cause implications médico-légale. Les manifestations cliniques peuvent êtres frustes et l’imagerie permet parfois d’avoir un diagnostic de certitude. Dans ce travail, nous présentons le cas d’un textilome retrouvé au niveau de l’espace épidural après cure d’une hernie discale réalisée deux ans auparavant et qui s’est révélé par des lombosciatalgies, ainsi que les facteurs humains et techniques impliqués dans cet événement indésirable

Métastases leptoméningées d’un adénocarcinome gastrique simulant un hématome extradural subaigu

Les métastases intracrâniennes sont de loin les tumeurs malignes les plus fréquentes du système nerveux central, puisqu’elles représentent un peu plus du quart des ces néoplasmes de l’adulte. Des formes simulant des méningiomes ou un hématome sous dural ont été décrites. Les métastases leptoméningées dans le cadre du cancer gastrique sont extrêmement rares. Observation: Un patient de 69 ans, ayant comme antécédent un adénocarcinome gastrique opéré il y a un an ; qui a présenté des céphalées rebelles aux antalgiques usuels et des troubles du comportement, faiblesse progressive de l’hémi-corps droit. L’examen neurologique trouve une hémiparésie spastique droite cotée à 4 /5 à prédominance brachiale, et un syndrome frontal. Un scanner et l’IRM cérébrale objectivaient une lésion extra-durale frontale gauche spontanément hyperdense à la TDM et en hyper signal T1 avec oedème à l’IRM. Une craniectomie frontale gauche effectuée, en urgence, a permis de découvrir une tumeur leptoméningée. L’examen histologique qui a confirmé l’origine gastrique. Discussion: Les métastases cérébrales se produisent dans environ 20% des patients atteints de tumeurs malignes. Le risque est plus élevé dans les cancers bronchiques et cancer du sein. Les métastases cérébrales des cancers gastriques sont extrêmement rares et diagnostiquées chez moins de 1% des patients touchés. La réponse au traitement est médiocre. Conclusion: Bien que son incidence ne soit que de 1%, mais il est particulièrement important d’en faire le diagnostic car, un traitement adapté spécifique combinant plusieurs armes thérapeutiques peut permettre une survie prolongée avec une bonne qualité de vie

Rola dynamicznej tomografii komputerowej złącza szczytowo-potylicznego przy ustalaniu postępowania w przypadkach stwierdzenia os odontoideum

Abstract Os odontoideum is an uncommon abnormality of the craniovertebral junction (CVJ) that exists as a separate ossicle apart from a hypoplastic dens. Its genesis and natural history have been debated, and its proper treatment remains uncertain. A 48-year-old woman complained of persistent upper neck pain and paraesthesia of her left side. Magnetic resonance imaging of the CVJ demonstrated an os odontoideum. Dynamic computed tomography scan of the CVJ showed a reduction of the space available for the spinal cord to 50% from extended to flexed position. The patient underwent posterior spinal fusion of C1–C2 using a sublaminar titanium hook and rods fixed in moderate extension. We discuss the usefulness of the dynamic computed tomography (CT) scan in the evaluation of atlantoaxial motion and the management of this pathology.Streszczenie Os odontoideum jest rzadko spotykaną nieprawidłowością złącza szczytowo-potylicznego, w której słabo wykształcony ząb obrotnika tworzy dodatkową kość. Sposób jej powstawania i historia naturalna są przedmiotem dyskusji; istnieje również niepewność co do właściwego postępowania. Czterdziestoośmioletnia kobieta zgłosiła się z powodu utrzymującego się bólu górnej części szyi oraz lewostronnych parestezji. W badaniu złącza szczytowo-potylicznego za pomocą rezonansu magnetycznego uwidoczniono os odontoideum. Dynamiczna tomografia komputerowa tej okolicy wykazała zmniejszanie się przestrzeni dostępnej dla rdzenia kręgowego o 50% podczas zgięcia w porównaniu z prostowaniem szyi. U chorej wykonano tylne zespolenie kręgów C1–C2 za pomocą tytanowego haka i prętów, uzyskując stabilizację szyjnego odcinka kręgosłupa w umiarkowanym wyproście. Autorzy omawiają przydatność dynamicznej tomografii komputerowej (TK) w ocenie ruchomości stawu szczytowo-obrotowego i w leczeniu wspomnianej patologii

Occipital lobe ependymal cyst with unusual presentation

Intraparenchymal cysts without communication to the ventricles or the subarachnoid space are named ependymal or epithelial cysts. The estimated ratio of their incidence compared with arachnoid cysts is 1:10. Neurologic deficit can occur when the cyst exerts mass effect on its surroundings. We report a case of cerebral ependymal cyst in a 75-year-old lady who presented with history of headache, vomiting and left incomplete homonymous hemianopsia. Neuroimaging studies showed a large right occipital cyst. She underwent the neurosurgical procedure of marsupialization. Histologic findings and the immunophenotype was consistent with a diagnosis of ependymal cyst. The patient made an excellent recovery after the procedure

Chronic subdural hematoma in the posterior fossa: A case report and review of the literature

Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare in the adult population. CT scanning is generally accurate and sufficiently sensitive in the diagnosis of supratentorial subdural hematomas, while MRI has clearly shown its superiority in the detection of subdural collections at unusual locations and particularly in the detailed analysis of the posterior cranial fossa. The surgical strategy is still controversial. We report a case of CSH in the posterior fossa successfully treated with a suboccipital craniectomy.  A 70-year-old man; has developed headaches, nausea, cerebellar syndrome and ataxia of walking. Radiological examinations revealed the appearance of a right CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient’s consciousness, urgent treatment was required. A small right suboccipital craniectomy was to access the hematoma. Postoperative computed tomography showed that the CSH and hydrocephalus had been successfully treated

Chronic subdural haematoma revealed by quadriparesis: A case report

Introduction: A subdural haematoma is an accumulation of blood between the brain and its surrounding dural covering which acts as a space-occupying lesion causing increased intracranial pressure and cerebral compression. Chronic subdural haematomas (CSDH) differ from acute subdural haematomas in so far as occurring mainly in the elderly. A history of direct head trauma is absent in upto 50% of cases. Case report: A 64-year old man, presented to the emergency centre with a sudden onset of right leg weakness. He initially denied any head injury but later recalled a minor head injury some weeks prior. Half an hour after presentation, his weakness progressed to a complete quadriparesis, while his sensory function remained intact and two hours after presentation he developed a complete flaccid quadriplegia. A CT scan was performed and revealed bilateral CSDH. Bilateral posterior and frontal burr holes were made under local anaesthesia, and 100 ml of blood was evacuated. Clinical improvement was almost immediately noted. After two days, his neurologic examination was without any abnormality. Discussion: CSDH is more common in the elderly. As reported here, clinical features may be delayed after the causal head injury (often weeks), and the trauma may even be forgotten. Cases manifesting bilateral haematomas are quite rare. The mechanism for quadriparesis is not fully understood. Motor deficit in the arms can be explained by direct compression or distortion of the cerebral hemispheres. This would not, however, account for motor weakness in the legs because the cortical areas responsible for the lower limbs would be relatively protected from the direct effect of compression. CSDH can present in many clinical scenarios, and may develop in the absence of a reported head injury. The diagnosis of CSDH should be considered in the differential when investigating cases of quadriplegia of uncertain aetiology, especially in the elderly population

Intracranial ependymal cyst with unusual presentation: Case report and review of literature

Background: Ependymal cysts remain a very rare cause of neurological symptoms among intracranial cystic lesions. It differs from an arachnoid cyst, as it does not communicate with subarachnoid space. Case description: A 33-year-old woman was admitted in our neurosurgery department with history of headache, vomiting and right unilateral blindness. Neuroimaging studies showed an intraparenchymal cystic lesion in the right frontal lobe with radiologic characteristic as seen in the ependymal cyst or hydatic cyst. She underwent the neurosurgical procedure of marsupialization and was discharged on day 6 post op. At one month follow up, the patient presented with a decrease vision acuity on the left eye, and head CT scan showed a recurrence of the cyst hence, we performed a second surgery with shunt procedure. Histological examination of the resected tissue demonstrated that, it was an ependymal cyst. Conclusion: Since there is often times a clinico-radiological discordance they are generally incidental findings in majority of cases. While complete surgical excision is the treatment of choice for the symptomatic cysts, cystic fluid diversion presents a better compromise nevertheless in cases where this may not be achieved. Keywords: Ependymal cyst, Brain, MRI, Surger