Spinal hydatid disease: diagnosis and management challenge of 20 cases

the aim of this study is to highlight the benefit of medical treatment in spinal hydatid disease. between 1984 and 1998, 20 cases of spinal hydatid disease were treated in our department. Plain x-ray was performed in all cases, computed tomography scan and myelography in 16 cases and 5 cases were explored by resonance imaging. Nineteen patients were surgically treated. Anthelmintic drugs [albendazole] were used parentally alone in 1 case and associated with surgery in 5 cases. We divided our patients into two groups: the first called "surgical group", has only surgical treatment without albendazole [14 patients] and the second, called "medicosurgical group" received albendazole alone or associated with surgical treatment [6 patients]. out of 20 cases, 11 were male and 9 were female. Patients' age ranged from 9 to 70 years, with an average of 32 years. The mean duration of symptoms before admission was six months. The most common sign was weakness in 18 cases; pain was present in 12 cases. The thoracic spine was involved in 9 cases, lumbar in 5 cases, thoraco-lumber in 2 cases, cervical, cervicothoracic and craniovertebral junction, in 1 case each. One vertebra was affected in 2 cases and more than one vertebra in 14 cases. The cyst was intradural but extra-medullary in 3 cases, epidural without vertebral involvement in one case. Evolution was characterised by total recovery in 4 cases without bone involvement. Among the 10 patients with vertebro epidural location, treated only surgically, 6 presented multiple recurrences and repeat surgery was often needed, 4 were totally or partially improved; 5 among the 6 patients who received anthelmintic drugs are living without evidence of recurrence during a period ranging from 1 to 6 years. we conclude that spinal hydatid is chracterised by a high rate of recurrence. Albebdazole used in our department since 1993, seems to change the course of the disease

Solitary infantile myofibromatosis of the orbit

Infantile myofibromatosis [IM] is an extremely rare cause of skull lesion in the new-born and paediatric population. The prognosis is related to the number of lesions and the presence or absence of visceral involvement. The authors report a case of IM, in a 5-year-old boy with an osteolytic lesion in the right orbital roof, which displaced the globe downwards. A subfrontal approach was made with total resection. The globe had regained a normal position and further evaluation revealed no other lesions. The patient's age at presentation, physical findings, radiographic appearance and the histopathological examination of the lesion are needed to generate a-differential diagnosis and to formulate a treatment plan

Spinal arachnoid cysts - 10 cases

The authors report their experience of 10 patients with spinal arachnoid cyst at the Hopital des specialties in Rabat. There were 5 females and 5males. The mean age was 27 years [range 6 to 70 years]. Eight patients had sings of spinal cord compression and the other two were admitted with severe sciatica. All patients had computed tomography-myelography or magnetic resonance imaging. The lesion involved the thoracic spine in 7, lumbar in 2 and cervical in 1 patient. The cysts were intradural in 6 an extradural in 4 patients. Treatment consisted of complete removal in 5 patients, marsupalisation in 3 and perforation aspiration in 2 patients. Follow-up ranging between 2-7 years, showed total improvement in 6 patients, partial recovery in 3 patients and 1 patient remained unchanged. Recurrence of the cyst was seen in 2 patients. The authors discuss the aetiology, pathogenesis, clinical, radiological and therapeutic aspects of this benign condition

Parinaud syndrome from tuberculoma of pineal area

Computerised tomography and magnetic resonance imaging [MRI] revealed obstructive hydrocephalus and a pineal mass in a 44-year-old woman who presented with headaches and Parinaud's syndrome. Although there was no major evidence of extracranial tuberculosis, and cerebrospinal fluid obtained during third ventriculostomy contained no leukocytes, stereotactic biopsy of the lesion revealed it to be a tuberculoma. MRI showed resolution of the lesion following antituberculous therapy. The implications of this case with regard to difficulties in the diagnosis of cerebral tuberculoma and the management of pineal region tumours are discussed

Lumbar spontaneous spinal epidural haematoma

Spinal epidural haematoma can be secondary to congential acquired coagulation disorder or rupture of a vascular malformation. However, sometimes none of these aetilogies are present, as in the case of our patient. The authors report a case of lumbar spontaneous epidural haematoma causing complications of a malignant systemic arterial hypertension in a 48-year-old patient, who had not presented signs of arterial hypertension previously. In this study, we discuss the clinical aspects, pathogenesis and exploration methods of this rare disease. Its characteristics are that it appears suddenly and constitutes a therapeutic emergency