Traumatisme vertebro-medullaire compliquant une spondylarthrite ankylosante

La survenue d’un traumatisme vertébral constitue un événement potentiellement grave dans l’évolution d’une spondylarthrite ankylosante (SPA). Le risque d’une atteinte médullaire est relativement élevé. Nous rapportons deux observations illustratives de la gravité du traumatisme vertébro-médullaire compliquant une SPA, avec une revue des différents facteurs de risque, et des aspects cliniques et thérapeutiques de la prise en charge dans cette situation

Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients

Respiratory viruses are opportunistic pathogens that infect the upper respiratory tract in humans and cause severe illnesses, especially in vulnerable populations. Some viruses have neuroinvasive properties and activate the immune response in the brain.These immune events may be neuroprotective or they may cause long-term damage similar to what is seen in some neurodegenerative diseases. The new “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) is one of the Respiratory viruses causing highly acute lethal pneumonia coronavirus disease 2019 (COVID-19) with clinical similarities to those reported in “Severe Acute Respiratory Syndrome Coronavirus” (SARS-CoV) and the “Middle East Respiratory SyndromeCoronavirus” (MERS-CoV) including neurological manifestation. To examine the possible neurological damage induced bySARS-CoV-2, it is necessary to understand the immune reactions to viral infection in the brain, and their short- and long-term consequences. Considering the similarities between SARS-CoV and SARS-CoV-2, which will be discussed, cooperative homological and phylogenetical studies lead us to question if SARS-CoV-2 can have similar neuroinvasive capacities and neuroinflammatiory events that may lead to the same short- and long-term neuropathologies that SARS-CoV had shown inhuman and animal models. To explain the neurological manifestation caused by SARS-CoV-2, we will present a literature review of 765 COVID-19 patients, in which 18% had neurological symptoms and complications, including encephalopathy, encephalitis and cerebrovascular pathologies, acute myelitis, and Guillain-Barré syndrome. Clinical studies describe anosmia or partial loss of the sense of smell as the most frequent symptom in COVID19 patients, suggesting that olfactory dysfunction and the initial ultrarapid immune responses could be a prognostic factor

Lipoblastome de la fosse sous temporale

Le lipoblastome est une tumeur bénigne rare, formée d'adypocytes immatures associés à la présence d'une matrice myxoide, de septas fibreux, et d'une architecture lobulaire. Il survient généralement chez le nourrisson et l'enfant. Cette tumeur touche dans la majorité des cas les tissus sous-cutanés des extrémités et du tronc. Elle est extrêmement rare au niveau de la tête et du cou. Un total de moins de 100 cas ont été rapportés précédemment dans la littérature

La place de la Callosotomie Microchirurgicale dans le traitement du syndrome de Lennox-Gastaut

Epilepsy is a common neurological disease. The intractable epilepsy is defined by the persistence of disabling seizures despite a well-conducted medical treatment involving the use of antiepileptic drugs and new molecules alone or in combination. In the case of refractory generalized epilepsy curative surgery is not possible, only a palliative surgery like callosotomy, radio surgical callosotomy and / or vagus nerve stimulation can be proposed. We report 3 cases of four patients with Lennox-Gastaut syndrome, who underwent a callosotomy performed in our neurosurgical department between 2003 and 2011. They were three boys with a mean age of 10 years (range 8 – 12 years). They all display Lennox-Gastaut syndrome manifested by servere atonic seizures with falls. The physical examination has found a right hemiparesis in one case. The electroencephalogram (EEG) identified a Lennox-Gastaut syndrome. Brain imaging (MRI and CT) was normal except from cortico-subcortical atrophy found in 1 children. After callosotomy, seizures decrised and no morbid mortality observed. The minimally invasive techniques, such as vagus nerve stimulation and radiosurgery give similar results in terms of efficiency with less morbidity and mortality, but the classic callosotomy remains affordable in developing countries.L’épilepsie est une maladie neurologique fréquente. L’épilepsie rebelle se définit par la persistance des crises d’épilepsie à une fréquence invalidante malgré un traitement médicamenteux bien conduit comportant l’usage des antiépileptiques classiques et des nouvelles molécules isolement ou en association. L’épilepsie réfractaire généralisée où un traitement chirurgical curatif n’est pas possible, seul un traitement palliatif à type de callosotomie microchirurgicale, de callosotomie radiochiorurgicale et /ou de stimulation du nerf vague peut être proposé. Nous rapportons trois observations chez des patients porteurs du syndrome de Lennox Gastaut, et ayant bénéficié d’une callosotomie microchirurgicale réalisée dans notre service de neurochirurgien entre l’année 2003 et l’année 2011. Il s’agit de 3 garçons âgés en moyenne de 10 ans (extrêmes : 8 à 12 ans) souffrant tous d un syndrome de Lennox qui se manifestait par des crises tonico-clinique avec une chute fréquente. L’examen somatique a retrouvé une hémiparésie droite chez un seul enfant. L’électro-encéphalogramme avait confirmé le diagnostic du syndrome de Lennox-Gastaut et l’imagerie cérébrale (IRM et TDM) était normale en dehors d’une atrophie cortico-sous corticale retrouvée chez un enfant. Après la callosotomie, une diminution du nombre des crises et des médicaments antiépileptiques prescrits a été observée avec une morbi mortalité nulle. Les techniques minimales invasives comme la stimulation du nerf vague et la radiochirurgie donnent des résultats similaire en terme d’efficacité avec moins de morbi mortalité, en revanche la callosotomie classique reste plus abordable dans les pays en voie de développement

Epilepsy: unusual presentation of cerebral hydatid disease in children

Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions even in the countries where the disease is endemic. Intracranial hydatid cysts are more common in children and occur more frequently in the supratentorial space. The aim of this paper is to describe the characteristic features of computed tomography (CT) and magnetic resonance imaging (MRI), and to determine the clinical presentation and surgical outcome of cerebral hydatid disease. A 7-year-old girl was admitted to the emergency department because of an epileptic attack. On radiological examination a round, cystic lesion appeared in the parietal lobe and caused shift of the midline structures. The cyst was successfully removed using the dowling technique. The postoperative period was uneventful and seizures were not seen during follow up. Hydatid cyst of the brain presents clinically as intracranial space occupying lesion and is more common in children, it is well demonstrated by CT and MR examinations, and Surgery is the treatment option with affordable morbidity and low mortality.The Pan African Medical Journal 2016;2

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)