[Intracranial aneurysm pronostics factors anout 22 ccases]

Ruptured intracranial aneurysms is uncommon but a serious disease with high morbidity and mortality. The follow-up is influenced by several factors. We presente 22 cases of intracranial anevrysms diagnosed after rup-tur in 21 cases. Age was varied between 14 years and 70 years. Eighteen patients were conscious or subcons-cious. Anevrysms were located in internal carotid artery in 44.3%. A good outcome [78.4%] was noted in patients who were WFNS I or II, with low or moderate subarachnoide hemorrage and supraclinoid iternal carotid artery aneurysms location

Non-traumatic spinal cord compression in children: 45 cases

Spinal cord compression occurs rarely in childhood and the diagnosis is usually made too late. We report 45 cases of non-traumatic spinal cord compression collected in our department between January 1982 and December 2002. Mean age was 11 years old with a male sex predominance [sex-ratio: 1.6]. Average delay of admission was 5 months. The most frequent complaints were gait disturbance [84.4%], pain [radicular or spinal] [66%] and sphincter dysfunction [24.4%]. Plain radiographs showed abnormalities in 46%. Magnetic resonance imaging has been more indicated since 1994. The distribution of lesions can be summerised as follows: predominance of dorsal involvement [37.7%], extramedullary lesions [75.6%] tumoural aetiologies [71.5%]. Forty-three cases were operated; 40 cases via posterior approach with laminectomy [33 cases] and laminotomy [7 cases], while anterior approach was performed in only 3 cases. Postoperative course showed neurologic improvement in 11 cases [24.4%], a stationary state in 28 cases [62.2%], and 3 cases of death. Unfortunately the long term outcome could not be followed in the majority of cases

Diagnosis and management of pituitary abscess

Pituitary abscess is a rare but serious intrasellar infection. To determine the signs and symptoms we present one case of a 40 year-old man without an infectious history nor of immunodepression, who had complained of severe headache, a right converge strablism, polyuria and polydipsia. The neurological examination was normal investigation of the old site was negative. Computerised tomography showed a pituitary adenoma. Magnetic resonance imaging [MRI] on the other hand, was in favour of a pituitary abscess: sellar hypointense T1-weighted, hyper-signal T2-weighted lesion with thin ring-enhancement following gadolinium injection. Transsphenoidal surgery was performed with a sterile culture. Anatomo-pathological study of the capsule showed nonspecific inflammatory tissue. Under antibiotherapy and after three months of clinical improvement, the symptomatology reappeared with a recurrence of the pituitary abscess on MRI. Drainage was carried out in the same manner as initially. Evolution under the same antibiotherapy was good with no recurrence of the pituitary abscess three years later. Pituitary abscess is a rare pathology, of difficult diagnosis even with MRI and often presents a surprise whilst operating. Outcome, except in recurrence, is excellent

Lymphome primitif du sein

They are rare tumors representing only 0,1% to 0,5% of all breast and chest neoplams. They have numerous diagnostical problems as well as clinical and anatomopathological difficulties. In fact the discordance between a benign mamographic image and clinical manifestations of malignancy should lead to suspicion of breast lymphoma. The histological examination should be completed by an immunohistochemical study that confirms the lymphomatous nature of the lesion. Prognosis is correlated to histological type. We reported a case of a female patient who consulted for a breast tumour and in whom the anatomopathological study confirms the diagnosis of a grand B cell lymphoma. We focus in our study on the clinical aspects of lymphoma and its therapeutic modalities with literateure review

[Cerebral hydatic cyst in children: a 40 cases report]

The cerebral hydatic cyst is uncommon, representing only 2 to 3% of all the localizations. Children are the most concerned by this disease. This retrospective study is about 40 cases of cerebral hydatic cyst [CHC] collected in the department of neurosurgery of Ibn Rochd Universitary Hospital of Casablanca between 1986 and 2002. These 40 cases were 70% of all the CHC. The mean age was 9 years [4 to 15 years. 64% were boys. All the children had progressive intracranial hypertension and 95% had neurological deficit. The cerebral CT scan of all the patients permitted to assess the diagnosis. The right hemispheric localization was predominant. 3 children had multivesicular cyst and 2 children had multiple cysts. All the patients were operated according to Arana-Iniguez's technique with a post-operative course characterized by 2 cases of meningitis. The medical treatment is still not useful for this disease. The outcome was good in 94% of the cases. 2 cases recurred after one and two years and had surgery once more. In conclusion, the CHC has a good prognosis in children if the diagnosis and the treatment are assessed early. Prevention campaign can avoid the disease and its neurological effects

Fractures of the odontoid process: 10 cases

The fractures of the odontoid process was exceptional, this complications was dramatic. In this retrospective study was about ten cases of fractures of odontoid process, collected at the department of neuro surgery between 1992-1998. The mean age of our patients was 27.4 years old, all patients are males. The highway accident was the most frequent etiology [90%]. The delay of consultation was were 3 days in 40% of the cases. The radiology study shows the existence of 9 cases of fractures type Ill and one case of fracture type according to ANDERSON and ALLONZO classification. The treatment was still orthopaedic in the majority of the cases, the surgery was indicated in the orthopaedic failures or in the primitively instable fracture. The evolution was characterised by the pseudarthrose complications in two patients and two cases was death

management of craniocerebral wounds about 73 cases

Our study was about 73 cases of craniocerebral wounds treated at the department of Neurosurgery in the UHC lbn Roshd in Casablanca. The mean age of our patients was 21 years old, with male predominance [87.7%]. 57.5% of these traumatisms were caused by aggression, 17,8% by road trafic accidents and 16.4% by falls. The neurological examination showed a normal consciousness in 80% of the cases, vigilance disorders in 20% of the cases, and signs of localizations in 23% of the cases. The radiography of the skull showed that the osseous damages [depressed fracture of the skull-pressed fracture of the skull were frequent in the parietal region [31%]. The computed tomography scan, achieved in all cases, was very useful in the detection of associated intracranial lesions. The management consists of a medical treatment and surgical intervention based on craniectomy and restoration of the dural plane. The craniocerebral wounds are rare but may have serious complications mainly infection and epilepsy