A rare cause of generalized seizures: agenesis and Lipoma of the corpus Callosum

An 18 years old young patient with no history presented to the emergency department suffering from episodes of generalized seizures and atypical headache without fever, the onset of symptoms dated back to two months. The clinical examination was normal. CT scan showed an inter hemispheric fat density ovoid formation, measuring about 40x30cm along major axis, compressing the ventricular junctions on both sides with suspected partial agenesis of the corpus callosum (figure 1a,b,c,d). MRI confirmed the partial agenesis of the corpus callosum (body and splenium); the lipoma was in high fat signal in T1 and T2 and was not modified by injection of gadolinium. This lesion showed arcuate peripheral calcifications, it was also hypointense on SPT1FAT SAT . The patient was stabilized using antiepileptic drugs. Intra cranial lipomas are rare benign tumors, its association with the agenesis of corpus callosum is also rare; the pathogenesis of such malformation is the premature disjunction of the neural ectoderms and skin before the closure of the neural tube. Epilepsy is the most common presentation of the Lipoma of the Corpus Callosum. It can reveal as a generalized seizures as for our patient but also as status epilepticus, partial motor or complex partial seizures. CT scan and especially MRI are the gold standard to diagnose these tumors. Surgical treatment has no place in this case, because of the anatomical relationship with adjacent structures especially with the anterior cerebral arteries which can be damaged

An unusual manifestation of hyperkalemia

An 82 years old patient was admitted to the emergency department complaining since 15 days of fatigue, dizziness and lipothymia. He had a history of hypertension and diabetes; and had undergone a coronary bypass in 2005. His physical examination showed a blood pressure at 160/50mmHg, a heart rate at 26cycles/min, and he was afebrile. On admission the ECG showed a third degree atrioventricular bloc with a regular rhythm at 26 cycles/min, P wave was absent, QRS complex was not wide (<0.10ms) and the T wave was not “tente like”, tall, peaked and symmetric, it was negative in the inferior territory and the ST segment was underlined in the laterobasal derivations. The laboratory findings included a serum potassium level of 6.9mEq/l (normal 3.6-5.5), sodium 132mEq/l (normal 135-140), creatinine 30mg/l (6-14) and urea nitrogen 0.82g/l (0.17-0.43), MDRD clearance was at 20ml/min (normal>80). The arterial blood gas analysis revealed a pH of 7.32, pO2=115mmHg, and pCO2=34mmHg. The patient was treated immediately with furosemide, bicarbonate serum, calcium gluconate, glucose solution, and insulin, after three hours, the ECG showed normal sinus rhythm with visible P waves, a heart rate at 60cycles/min and a shortening of the QT interval in comparison with the first ECG. Blood potassium at this moment was at 5.60mEq/l. Hyperkalemia is known to cause a depression of the conduction velocity and excitability of the pacemaker cells and conduction tissues, resulting generaly in an advanced atrioventricular bloc with wide QRS complex. In this case the QRS remained normal

Aneurysmal dilatation of the pulmonary artery trunk and its major branches

A 34-year-old woman with history of post rheumatic mitral stenosis since the age of 12 years at the stage of surgery (the patient refused it). She was admitted for cough and dyspnea of acute onset without fever or chest pain. The patient was in respiratory distress, afebrile and hemodynamically stable. Arterial blood gas analysis showed PaO2 = 48mmHg, PaCO2 = 56mmHg and pH = 7.26. Clinical examination found signs related to mitral stenosis and congestive heart failure. The electrocardiogram showed atrial fibrillation. Chest radiography showed no signs of pneumonia but highlighted cardiomegaly with a prominent left median arc and ectasia of the lower right arc (A). Doppler echocardiography showed a tight mitral stenosis with mitral area of 0.6 cm2 and a dilated left atrium and right cardiac cavities. It also revealed a significant tricuspid regurgitation and a major pulmonary hypertension with a systolic pulmonary artery pressure at 97 mmHg. The chest CT objectified aneurysmal dilatation of the pulmonary artery (8.2 cm) and its branches without signs of pulmonary embolism (B). The patient improved after non-invasive ventilation and diuretic treatment. Proximal pulmonary artery aneurysms, defined by a ratio of pulmonary artery to aortic diameter greater than two, are rare and bilateral aneurysms were exceptionally described. The causes are dominated by infectious diseases, inflammatory arteritis, and congenital heart disease and acquired valvular heart disease. Pulmonary arterial hypertension can cause chronic aneurysm of the pulmonary artery by direct infringement of the wall with atherosclerosis, medianecrosis and aneurysmal distension.Pan African Medical Journal 2015; 2

Kyste hydatique du foie révélé par sa fistulisation dans le thorax

Une patiente âgée de 28ans, sans antécédent pathologique particulier, avec notion de contact avec les chiens (hébergement d'un chien au domicile), accusait depuis 2 mois des douleurs basithoraciques droites avec gêne respiratoire. Dix jours avant son hospitalisation, le tableau s'est aggravé par l'apparition d'une toux sèche, une asthénie et une fièvre. L'examen clinique a révélé un syndrome d'épanchement basi thoracique droit. La patiente a bénéficié d'une radiographie thoracique de face (A), qui montrait un épanchement liquidien pleural droit de moyenne abondance sans foyer parenchymateux visible. Une tomodensitométrie thoracoabdominale a montré un épanchement liquidien pleural droit associé à une scissurite, l'épanchement communiquant par le biais d'une fistule avec une lésion arrondie, hypodense, bien limitée du dôme hépatique, renfermant une calcification périphérique et ne se rehausse pas après injection de produit de contraste (B). Le complément échographique réalisé a confirmé la présence de la lésion du dôme hépatique avec les caractères sémiologiques suscités (C). Biologiquement, on notait une discrète élévation de la VS à 15mm la première heure avec une sérologie hydatique positive. La patiente a bénéficié d'une chirurgie avec drainage de liquide pleural et fermeture de la fistule. L'évolution post opératoire était favorable. Le kyste hydatique est une parasitose due au développement de la forme larvaire d'échinococcus granulosus. L'hôte habituel est le chien, l'homme étant l'hôte intermédiaire. Toutes les localisations sont possibles. La fistulisation dans le thorax est beaucoup plus rare et varie de 2 à 5% selon les séries.Pan African Medical Journal 2015; 2

Complication rare et grave de la rachianesthésie: la méningite bactérienne (à propos d’un cas et revue de la littérature)

La rachianesthésie (RA) est la première anesthésie locorégionale. Elle comporte des effets secondaires et des risques qu'il faut pouvoir éviter, prévenir ou traiter précocement. C'est le cas d'une patiente opérée sous rachianesthésie qui a présenté quelques jours après l'interventionde céphalées intenses associées à des nausées et des vomissements évoluant dans un contexte de fièvre. La ponction lombaire mettait en évidence un liquide trouble avec la présence de cocci gram + à l'examen direct, ce qui a permis de poser le diagnostic d'une méningite bactérienne et dont l'évolution a été favorable après antibiothérapie.Mots clés: Méningite bactérienne, rachianesthésie, nosocomiale, complication grave, asepsieEnglish Title: Rare and severe complication of spinal anesthesia: bacterial meningitis (about a case and literature review)English AbstractSpinal anesthesia (SA) is the first locoregional anesthesia. It can cause side effects and carry risks that need to be avoided, prevented or treated early. We here report the case of a female patient operated under spinal anesthesia who had intense headache associated with nausea and vomiting evolving in the context of fever within a few days after surgeryLumbar puncture showed cloudy liquid revealing Gram + cocci on direct examination. This allowed the diagnosis of bacterial meningitis. Patient’s evolution was favorable after antibiotic therapy.Keywords: Bacterial meningitis, spinal anesthesia, nosocomial, serious complication, asepsi

Thrombolysis for acute ischemic stroke by tenecteplase in the emergency department of a Moroccan hospital

Introduction: Thrombolysis has radically changed the prognosis of acute ischemic stroke. Tenecteplase is a modified form of rt-PA with greater specificity for fibrin and a longer half-life. We report the experience of a Moroccan tertiary hospital in thrombolysis using Tenecteplase. Methods: We conducted an open prospective study of all patients who were treated with Tenecteplase for an acute ischemic stroke admitted to our emergency department. Tenecteplase was administered intravenously at a dose of 0.4 mg/kg single bolus. The primary outcome measure was the proportion of patients achieving significant early neurological recovery defined as an improvement of 4 or more points on the NIHSS score at 24h. Results: 13 patients had been treated by intravenous thrombolysis. 31% were women. Mean age was 63 years old. The mean NIHSS score at admission was 14.3 and 24h after was at 9.1. The right middle cerebral artery was involved in 69% of cases. The carotid atherosclerosis was predominant 63.3% and the cardio embolic etiology 27%. The mean time to the first medical contact after the onset of symptoms was 3h 30 min. One patient presented a capsulo-lenticular hematoma of 5 mm3 in the same side of the ischemic stroke. Conclusion: Tenecteplase is a more interesting thrombolytic than alteplase, it seems to be more suitable for thrombolysis in our center.Keywords: Acute ischemic stroke, thrombolysis, tenecteplas

Spinal hydatidosis mimicking Guillain Barre syndrome: in case of doubt there is no rush to perform lumbar puncture

Guillain Barre Syndrome (GBS) is a challenging pathology which diagnosis is based essentially on the clinical examination and the results of lumbar puncture. Differential diagnosis must be discussed if the clinical picture is not complete. We present the case of a patient who presented to the emergency department with symptoms evoking both GBS and spinal cord compression. The Radiology showed a diffused spinal hydatidosis. The lumbar puncture must be carefully considered. In this case, it would have exposed the patient to hydatid dissemination

Hydatid cyst of the pericardium: a case report

Pericardial hydatid cystis a rare condition; its clinical presentation is variable. It can reveal straightaway at the stage of life threatening complications. We report the case of a 17 years old female Arab patient, who complained of as udden on set dyspnea, clinical examination was poor; the diagnosis was suspected by echocardiography and confirmed by the CT scan and hydatid serology. Furthermore, no other location was noted. Surgical treatmentwas proposed. The modern cross-sectional imaging especially CT scan and MRI revolutionized the diagnosis of this rare hydatid location

Synthesis, crystal structure and mono-dimensional thallium ion conduction of TlFe(0.22)Al(0.78)As(2)O(7)

A new solid solution TlFe0.22Al0.78As2O7 has been synthesized by a solid-state reaction. The structure of the title compound has been determined from a single-crystal X-ray diffraction and refined to final values of the reliability factors: R(F2) ¼ 0.030 and wR(F2) ¼ 0.081 for 1343 independent reflections with I42s(I). It crystallizes in the triclinic space group P-1, with a ¼ 6.296(2)A ˚ , b ¼ 6.397(2)A ˚ , c ¼ 8.242(2)A ˚ , a ¼ 96.74(2)1, b ¼ 103.78(2)1, g ¼ 102.99(3)1, V ¼ 309.0(2)A ˚ 3 and Z ¼ 2. The structure can be described as a threedimensional framework containing (Fe/Al)O6 octahedra connected through As2O7 groups. The metallic units and diarsenate groups share oxygen corners to form a three-dimensional framework with interconnected tunnels parallel to the a, b and c directions, where Tl+ cations are located. The ionic conductivity measurements are performed on pellets of the polycrystalline powder. At 683 K, The conductivity value is 5.23106 S cm1 and the ionic jump activation energy is 0.656 eV. The bond valence analysis reveals that the ionic conductivity is ensured by Tl+ along the [001] directio

Une dysphagie révélant une artère sous-clavière droite aberrante: à propos d’un cas

Nous rapportons le cas d'une patiente ayant une dysphagialusoria, c'est-à-dire une dysphagie en rapport avec un trajet aberrant de l'artère sousclavière droite. Le diagnostic a été confirmé par un angioTDM thoracique et une artériographie des troncs supra-aortiques. Le traitement est toujours chirurgical.Pan African Medical Journal 2016; 2