[Exertional heat stroke: about 4 cases]

Exertional heat stroke is defined as hyperthermia associated with neurological signs related to intense physical activity performed in a hot environment. This is a medical emergency and life-threatening. In this study, we investigated four cases of exertional heat stroke hospitalized at the military hospital in Tunis [Tunisia] to describe the clinical, therapeutic and preventive characteristics and factors favoring this disease. Four young soldiers, 23 to 44 years older, have developed Exertional heat stroke after Intense and prolonged exercise. Exercises were performed in May and June, in high ambient temperature, high humidity and lack of wind. Three soldiers were in battle dress, a backpack and their weapon. Our four subjects had overweight, were not sufficiently trained and were highly motivated. Insufficient hydration and a diet rich in carbohydrates were noted. Upon hospitalization, patients were febrile and had neurological disorders, neuromuscular disorders, rhabdomyolysis and hemoconcentration. The medical care consisted of a rehydration and oxygen

[Screening of viral hepatitis c in a young tunisian population [more than 175,000 recruits]]

Background: In front of the considerable impact of the viral hepatitis C, the prevention is more than ever a priority, based essentially on the screening

Aim: We realized an epidemiological study in a population of young recruits with the aim of considering prevalence of anti-hepatitis C Virus [anti-HCV] antibodies, describing its epidemiological evolution and establishing a cartography of the viral hepatitis C in Tunisia

Methods: Epidemiological retrospective study of prevalence was realized from the data of the screening of anti-HCV antibodies from 2003 till 2012 of all the young recruits suggested to be incorporated for the national service or suggested to be recruited as career soldier. The study was exhaustive concerning 175 322 young and healthy male adults aged between 20 and 30 years old, originating from all parts of Tunisia. The screening was realized by third and fourth generation ELISA tests then validated by Immunoblot

Results: The prevalence was 0.11% and the confirmed prevalence was 0.07%. The positive subjects were mainly between 20 and 25 years old [82.32%] and 91.05% were detected within the framework of their incorporations to the national service. The lowest prevalence was 0.07% in 2004, and the highest was 0.17% in 2011, without a significant tendency in the increase or in the decrease during the period of study [r = 0.857 ; p = 0.564]. The screening of anti-VHC antibodies had an unequal geographical distribution according to a North-South decreasing gradient. The highest proportions were registered in the North-West [23.23%] and the District of Tunis [22.73%], contrary to the South-East which was weakly affected [3.54%]. The governorates with the highest proportions were Tunis [19.19%], Bizerte [11.62%] and Jendouba [8.59%], the governorates of Monastir and Tataouine were weakly affected [0.51%]

Conclusion: Prevalence of anti-HCV antibodies in the young and male Tunisian population was weak, stable without significant tendency in the increase or in the decrease from 2003 till 2012, characterized by an unequal geographical distribution according to a North-South decreasing gradient

Transcranial Doppler and cerebral tomodensitometry scan in the predictivity of intracranial hypertension

To compare transcranial Doppler ultrasonography [TCD] and cerebral tomodensitometry [CT], in the predictivity of intracranial hypertension [ICH]. Sixteen patients, with a median age of 47 years, under continuous monitoring of intracranial pressure [ICP] were included in a double blinded prospective study. Each time a CT was performed the left and right middle cerebral arteries were insonated. With TCD, ICH is noted if the worst mean blood flow diastolic velocity was less than 25 cm/s, associated with a pulsatility index value larger than 1.2. Cerebral tomodensitometry was analysed and the ICH noted if one or more of the following radiographic signs was present [disappearance of sulci, effacement of ventricles, reduction of the white-grey matter differentiation, basal cistern compression, hydrocephalus and midline shift higher to 5 mm]. The median initial Glasgow Coma Score was 8 +/- 3. Intracranial pressure monitoring was undertaken in the following situations: 10 severe head injury, 4 strokes and 2 cerebral tumours. A total of 30 CT were carried out. Fourteen patients presented at least one episode of ICH. During episodes of ICH, TCD correlated with ICP in 64% of the cases, whereas CT correlated with ICP in 68% of the cases. In the absence of ICH the correlation of TCD and ICP decreased to 37.5%. In 4 cases of ICH, data of CT were not in favour of ICH while TCD correlated with ICP. Associating TCD and CT allows to detect ICH in 86% of cases vs. 68% only with CT [p=0.15] and vs. 64% only with TCD [p=0.08]. Transcranial Doppler ultrasonogrpahy is equivalent to CT in the predictivity of an ICH. This predictability is better in cases of ICH [ICP > 20 mmHg]. Associating TCD to CT allows to recover the majority of the cases of ICH not detected by CT alone

Arachnoid cyst mimicking intramedullary spinal cord tumour

Arachnoid cysts are intra-arachnoid collections of cerebrospinal fluid [CSF] that produce neurologic symptoms either by compressing adjacent neural tissue or by obstructing CSF flow. This is a case of symptomatic arachnoid cyst at C5-C6 level in a 20-year-old man with intradural tumours suspected as neuroenteric cyst, epidermoid cyst or low grade glioma. The past medical history of this patient was non-contributory. There was no cervical spine trauma and no causative factors of arachnoiditis. The cyst was widely fenestrated and postoperatively the patient experienced progressive improvement of weakness, numbness and sensory deficits. The authors report this case and discuss the rarity of such a lesion, the mechanism of formation, clinical significance and radiological features

[Orbital eosinophil granuloma. case report and review of the literature]

Eosinophyl granuloma is a rare tumor affecting mainly children, involving the vault more frequently than the skull base. Treatment is mainly surgical, adjuvant therapies can be used only in special cases. The report is about a case of a 8-year-old girl presented with a right frontal mass and a non-significant exophthalmia; neuroradilogicaI investigations showed a non-painful front lateral mass with bone erosion in regard. Surgery revealed an invasive tumor for the temporal bone and muscles. Histological, epidemiological and radiological features are discussed in the study