Difficultés diagnostiques de la tuberculose cérébrale / Diagnostic difficulties of cerebral tuberculosis

La tuberculose est une des maladies infectieuses les plus répandues dans le monde .Elle représente un problème de santé publique majeur dans les pays en voie de développe ment, y compris l'Algérie . À l'échelle mondiale et parmi tous les cas de tuberculose, l'OMS rapporte 14 % de tuberculose extra-pulmonaire (TEP) sans atteinte pulmonaire concomitante. Dans notre pays et durant ces dernières années, une recrudescence de la tuberculose extrapulmonaire a été observée. L'objectif de cet article était de présenter un cas atypique de tuberculose cérébrale dont le diagnostic a été tardif, posé par l'examen anatomopathologique avec une revue de la littérature. C'est le cas d'une jeune patiente hospitalisée dans le cadre de l'urgence pour un syn drome d'hypertension intracrânienne avec troubles neurologiques. La tomodensitomé trie cérébrale a objectivé de multiples localisations cérébrales avec une hydrocéphalie active. Le bilan d'extension était sans anomalie. La patiente avait bénéficié d'une inter vention chirurgicale, les suites opératoires ont été favorables. L'examen anatomo-pa thologique était en faveur d'une lésion inflammatoire spécifique granulomateuse faite de larges plages de nécrose caséeuse. La patiente a répondu au traitement antituber culeux. Le problème diagnosticque et les résultats seront discutés avec une revue de la littéra ture. La tuberculose cérébrale est une forme rare de la tuberculose extra-pulmonaire. Le tableau clinique ainsi que la neuro-imagerie (TDM, IRM) sont atypiques. Le diagnostic était postopératoire, reposant sur l'examen anatomopathologique. Le pronostic dépend de la précocité du diagnostic, du siège de la lésion et de la réponse au traitement antituberculeux.

Tuberculosis is one of the most widespread infectious diseases in the world. It constitutes a major public health problem, especially in developing countries, including Algeria. Globally and among all tuberculosis cases, WHO reports 14% extra-pulmonary tuberculosis (EPT) without concomitant pulmonary involvement. In our country and in recent years, an upsurge in extrapulmonary tuberculosis has been observed. The objective of this article was to present an atypical case of cerebral tuberculosis whose diagnosis was late, made by anatomopathological examination with a review of the literature. We report the case of a young patient hospitalized in emergency for an intracranial hypertension syndrome with neurological disorders. Cerebral computed tomography revealed multiple brain locations with active hydrocephalus. The extension assessment was without anomaly. The patient underwent a surgical intervention, the operative consequences were favorable. The pathological examination was in favor of a specific inflammatory granulomatous lesion made up of large areas of caseous necrosis. The patient was cured under anti-tuberculosis treatment. The diagnostic problem and the results will be discussed with a review of the literature. Cerebral tuberculosis is a rare form of extrapulmonary tuberculosis. The clinic as well as the neuroimaging (CT, MRI) are atypical. The diagnosis is postoperative, based on the pathological examination. The prognosis depends on the early diagnosis, the site of the lesion and the response to anti-tuberculosis treatment.

Assessment of Adult's Abdominopelvic Computed Tomography Radiation Doses in Amhara Region, Ethiopia

BACKGROUND: Computed Tomography plays a priceless role for diagnostic and therapeutic purpose; however,applying an optimized Computed Tomography Technique to produce qualified image while delivering minimum radiation dose to patients is the common challenge. The main objective of this study was to establish local diagnostic reference levels for adult patients who visited abdominopelvic Computed Tomography examination. METHODS: A total of 158 patients who had taken abdominopelvic Computed Tomography examination from three selectedAmhara region hospitals were investigated. Both prospective and retrospective techniques of data collection were used while collecting the data in the entire sample. Two GE - Optima Computed Tomography 540 (16 slices) and one Phillips ­ Brilliance (64slices), were employed during data collections. Data for patient demographics scan protocols, Computed Tomography dose descriptors and machine specifications were collected and analyzed by using SPSS software version 26. RESULTS: The third quartile estimated computed tomography dose index volume and dose length product, which is the local Diagnostic Reference Levels, were 12 mGy and 1904 cm.mGy respectively. The investigated local Diagnostic Reference Levels of Computed Tomography Dose index volume (mGy) was comparable to other international Diagnostic Reference Levels. However, the third quartile value of dose length product (cm.mGy) was higher than other reported international Diagnostic Reference Levels. CONCLUSION: The values of local Diagnostic Reference Levels presented in this work can be used as a baseline upon which future dose measurements can be compared in Amhara region

Morphological Variation of Third Ventricle Using Computerized Tomography among Different Gender and Age Groups: A 5-Year Retrospective Study in Usmanu Danfodiyo University Teaching Hospital; Sokoto; North - West Nigeria

Background: Many methods have been described for measurements of the third ventricle as a means of evaluating brain atrophy during the normal aging process and disease. Enlargement of the cerebral ventricles is one of the most frequently replicated neurobiological findings in schizophrenia. The aim of this morphological study was to examine the range in the normal size of the third ventricle of individuals living in Sokoto and to assess its association with gender and age. Materials and Methods: All available brain CT in the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto; Nigeria; from 2007 to 2012 (a 5-year period) and reported as normal by the radiologist were recruited for the study. Films were viewed on the computer monitor. Measurements were made with Dragon V 3.1.1 Philips and Neusoft Medical System Company Limited software; the software provides a meter rule with which measurements were done. Results: A total of 252 CT scan images where used in the study. Of this number; 156 (61.9) were CT scan images of males and 96 (38.1) were CT scan images of females. The mean width was 8.38 mm and mean anteroposterior length was 12.16 mm. These differences were statistically significant; P = 0.0209 (0.05). Conclusion: Our findings provide a base line data for the measurement of the third ventricles using CT scans in our environment and this may be applied in various clinical conditions involving the third ventricle

Brain Computed Tomography of Patients with HIV/AIDS before the Advent of Subsidized Treatment Program in Nigeria

Background: The objective is to study intracranial complications of HIV/AIDS using brain-computed tomography in patients who presented with neurological features before the advent of subsidized HIV/AIDS treatment program with highly active antiretroviral therapy (HAART) in Nigeria. Materials and Methods: Retrospective study of patients' records retrieved from radiology and medical records departments of the hospital. The studied patients had HIV/AIDS and presented with neurological features and underwent CT scan. Results: A total of 36 patients who tested positive for HIV and who presented with neurological features suspected to be complications of AIDS were examined with CT scan. They consisted of 24 male and 12 females. The male to female ratio was 2:1. The age of the patients ranged from 27 to 45 years. Seventeen patients (47.2) were aged 30-34 years. Twenty-four patients (60) were single while 12 (40) were married. Twenty-seven patients (75) were infected with HIV 1 and 2; five patients (13.9) were infected only with HIV-1 while four were infected with only HIV-2. Presenting neurological complaints include left hemiplegia 13 (36.1); right hemiplegia 6 (16.7); coma 7 (19.4); memory loss/dementia complex 5 (13.9); convulsion with coma 2 (5.6); left hemi-pariesis with memory loss 2 (5.6); and staggering gait 1 (2.8). The findings in CT scan include infarcts-like lesions 14 (38.9); multiple ring-enhancing lesions 7 (19.4); cerebral atrophy 5 (13.9); multiple nodular lesions 4 (11.1); acute intracerebral hemorrhage 3 (8.3); cerebral hemiatrophy 2 (5.6); and solitary ring-enhancing lesions 1 (2.8). Eight patients with single or multiple ring enhancing lesions were treated with empirical treatment for toxoplasmosis but only three (37.5) made full recovery. Conclusion: Brain CT scan showed extensive structural damages in patients with HIV/AIDS who were not treated with HAART. Out-of-pocket payment for investigations and treatment and absence of HAART could be partly responsible for high rate of advanced disease

Radiation Dose in Paediatric Computed Tomography: Risks and Benefits

Computed tomography (CT) is a powerful tool for the accurate and effective diagnosis and treatment of a variety of conditions because it allows high-resolution three-dimensional images to be acquired very quickly. However as the number of CT procedures performed globally have continued to increase; with growing concerns about patient protection. Currently; no system is in place to track patient doses and the lifetime cumulative dose from medical sources. The widespread use of CT even in developing countries has raised questions regarding the possible threat to public health especially in children. The best available risk estimates suggest that paediatric CT will result in significantly increased lifetime radiation risk over adult CT. Studies have shown that lower milliampere-second (mAs) settings can be used for children without significant loss of information. Although the risk-benefit balance is still strongly tilted toward benefit; there is still need for caution. Furthermore since the frequency of paediatric CT examinations is rapidly increasing; and estimates suggest that quantitative lifetime radiation risks for children are not negligible; efforts should be made toward more active reduction of CT exposure settings in paediatric patients. This article hopes to address this concerns and draw attention to the fact that children are not 'small adults ' and should therefore be treated differently

Detection of early Glaucomatous Damage in Pseudo Exfoliation Syndrome by Assessment of Retinal Nerve Fiber Layer Thickness

Purpose : To detect early glaucomatous changes in pseudo exfoliative patients with normal intraocular pressure (IOP); visual field and optic nerve head appearance; by measuring retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT). Design : A prospective observational case-control study. Participants : Twenty non-glaucomatous (normal IOP; fundus and visual field) pseudo exfoliative patients and 20 age matched healthy control subjects. Materials and Methods : The RNFL thickness (global and four quadrants) was assessed using combined imaging system OTI (OCT/SLO) and compared with age matched normal control subjects. Results : The RNFL in patients with pseudo exfoliation syndrome (PXS) was significantly thinner in all quadrants except the nasal quadrant compared to the control group (p less than 0.05). Conclusion : Measurement of RNFL thickness by OCT is useful in detecting early RNFL damage which in turn provides clinically relevant information in detecting early glaucomatous changes in pseudo exfoliative patients

Plain radiographic cephalometry of the sella turcica: an overview

Background: The simplest of the parameters in anthropometry; including; height; weight; length; thickness and widths of various parts of the body vary from tribe to tribe and from one race to the other; and measurements of these parameters also differ amongst different age groups and between the two sexes as well. Method: A review composed via Medline Internet search; literature search and contributions from our experiences as well as experiences from colleagues. Results: Studies on measurements of the Sella turcica have revealed variations in the size of the fossa with certain parameters such as age; sex e.t.c. Conclusion: It is concluded that complete study of the Sella turcica requires multidirectional tomography

Parotid lymphomas - clinical and computed tomographic imaging features : otolaryngology

Objective. To review the clinical presentation and computed tomography (CT) imaging characteristics of all parotid lymphomas diagnosed at the study institution over a 7-year period. Design. Retrospective chart review of parotid lymphomas diagnosed between 1997 and 2004. Subjects. A total of 121 patients with parotid lesions were identified. After retrospective chart review; a total of 10 patients with histologically proven parotid lymphoma were included in the study; 8 of whom had CT scans available for assessment. Results. Ten patients with histologically proven lymphoma of the parotid gland were identified from among 121 patients with parotid neoplasms; an incidence in this series of 8.3. All lymphomas were of nonhodgkin's type. All patients presented with a painless unilateral parotid swelling. Most patients had a short history of less than 4 months' duration; of whom 3 presented with a rapidly evolving swelling of less then 1 month's duration. No patient had a background of SjA gren's disease or any other autoimmune disorders. The commonest finding noted on CT was of a unilateral; single mass of relative soft-tissue homogeneity with poorly defined; indistinct tumour margins. Associated loco-regional lymphadenopathy was identified in 2 cases; 1 clinically and another radiologically; multiple ipsilateral lesions were noted in 2 cases. No cases of contralateral disease were observed. Conclusion. Lymphoma has a clinical presentation similar to other neoplasms arising within the parotid gland. A unilateral; non-tender swelling was a universal finding. A history of less than 4 months may suggest the possibility of lymphoma. CT scanning is a useful adjunctive investigation to determine the site and extent of the disease; loco-regional nodal status and contralateral gland and neck status. Multifocality and associated adenopathy are associated with; but not exclusive to; parotid lymphoma. Although poor tumour boundary definition on CT imaging is a strong predictor of malignancy; no pathognomonic finding specific for lymphoma has been identified. The potential diagnosis of parotid lymphoma should be considered in all patients who present with a parotid mass

Usefulness of multi-detector row computed tomography for accurate preoperative assessment of pancreatic adenocarcinoma: report of a case

A 74-year-old female underwent surgical treatment for adenocarcinoma of the pancreatic head. Preoperative multi-detector row computed tomography (MD-CT) demonstrated tumor invasion into the accessory right colic vein and the branch of the middle colic artery (MCA); which was not detected by digital subtraction angiography. MD-CT showed anatomical variants in the left hepatic artery arising from the left gastric artery; and the right posterior hepatic artery arising from the superior mesenteric artery. Three-dimensional reconstruction CT generated a clear picture of the anatomy of the region concerned; which is essential for a safe operation. The MD-CT findings were highly consistent with the intra-operative findings. We have demonstrated that MD-CT is an important and highly accurate modality for pancreatic surgery

Empty sella syndrome: Incidential findings at computerised tomography

A 43-year old female patient presented with severe dizziness; neck pain and headache. Clinical examination revealed diplopia with a horizontal gaze. Plain skull radiographs showed an enlarged sella turcica with no abnormal intracraial calcifications. Pre and post contrast axial and post contrast coronal computerised tomography scans through the sella turcia were done. an enlarged sella turcia filled with cerebrospinal fluid was demonstrated

Lymphagiome kystique cervical: apport de l'echographie et de la tomodensitometrie: a propos d'un cas. [Lette]

Les auteurs; a partir d'un cas de lymphagiome kystique cervical; signalent l'apport de l'imagerie medicale; surtout de l'echographie et la tomodensitometrie; dans le diagnostic de cette affection rare

Les accidents vasculaires cerebraux a Kinshasa: etude tomodensitometrique

Au bout de 4 ans (juillet 88-juillet 92) de pratique d'une technique nouvellement acquise; la tomodensitometrie par ordinateur (TDM) dans notre milieu; les auteurs analysent 121 cas d'accident vasculaire cerebral (AVC) chez les Noirs Africains de Kinshasa. L'AVC est une pathologie du sujet jeune et plus frequemment chez celui du sexe masculin (2/1). L'hemorragique est moins frequent que l'ischemique (2/3). L'AVC survient dans le territoire de l'artere cerebrale moyenne (77;5 pour cent) et plus volontiers a gauche. L'hypertension arterielle reste l'antecedent morbide le plus rencontre suivi de la drepanocytose

Review of carotid angiograms in evaluation of intra cranial lesions prior to the advent of computerized tomography (CT) scan in Ghana (1982-1992)

Cerebral arteriography was first introduced in Spain by Egax Monizs in 1927. In Ghana; carotid angiograms performed at the Korle-Bu Teaching Hospital between the mid sixties and the late seventies were done by non-radiologists. Cerebral angiography has been used for evaluation of intracranial mass lesions; patients with vascular abnormalities; transient ischaemic attacks; cerebrovascular accidents and for investigation of head injuries. The aim of the study is to review all the carotid angiograms of the last 10 years prior to the advent of CT scan in Ghana and also to form the basis for future research