Isolated thoracic intradural extramedullary epidermoid cyst: A technical note.

Background: Congenital, acquired, and iatrogenic spinal epidermoid cysts (EC) are very rare. Methods: A 62-year-old female patient presented with a 5-month history of progressive paraparesis leading to paraplegia secondary to a posterior compressive intradural extramedullary lesion at the T7 level. The patient underwent a laminectomy/durotomy for gross total tumor excision. Results: Histopathology confirmed the lesion was an epidermoid cyst. Although her spasticity improved within 5 weeks, she only regained partial lower extremity motion (i.e., 3/5 motor function). Conclusion: Patients presenting with the acute/subacute onset of paraparesis secondary to spinal EC should undergo timely gross total cyst resections to optimize neurological outcomes.

Association of limited dorsal myeloschizis and corpus callosum lipoma: A case report and literature review.

Background: Intracranial lipomas are a rare clinical entity. These lesions are frequently asymptomatic and originate in the pericallosal area. As they are fat-containing lesions which are intimately attached to the surrounding structures, surgery is not recommended. In some individual reports, subtotal resection is recommended to lessen complications. There have been no previous reports of corpus callosum lipoma (CCL) associated with limited dorsal myeloschizis (LDM). Case Description: We describe the case of a combination of CCL and bilateral choroid plexus lipoma discovered incidentally during the investigation of LDM in a 3-month-old male child. Given the asymptomatic behavior of the lipoma and the vascular elements of the pericallosal area, it was decided to monitor it regularly. Thus, the patient underwent surgery only for LDM. Histological examination confirmed the diagnosis, and postoperative follow-up 1 year after showed good evolution. To the best of our knowledge, this association has never been described in the literature. Conclusion: This case suggests a possible developmental relationship between CCL and spinal dysraphism.

Phenotypic characterization of human peripheral γδT-cell subsets in glioblastoma.

The antitumoral contribution of γδT cells depends on their activation and differentiation into effectors. This depends on different molecules and membrane receptors, which conditions their physiology. This study aimed to determine the phenotypic characteristics of γδT cells in glioblastoma (GBM) according to five layers of membrane receptors. Among ten GBM cases initially enrolled, five of them who had been confirmed by pathological examination and ten healthy controls underwent phenotyping of peripheral γδT cells by flow cytometry, using the following staining: αßTCR, γδTCR, CD3, CD4, CD8, CD16, CD25, CD27, CD28, CD45, CD45RA, CD56, NKG2D, CD272(BTLA), and CD279(PD-1). Compared with the controls, the results showed no significant change in the number of γδT cells. However, there was a decrease of double-negative (CD4- CD8- ) Tγδ cells and an increase of naive γδT cells, a lack of CD25 expression, a decrease of the expression of CD279, and a remarkable, but not significant, increase in the expression of the CD27 and CD28 costimulation markers. Among the γδT cell subsets, the number of Vδ2 decreased in glioblastoma and showed no significant difference in the expression of CD16, CD56, and NKG2D. In contrast, the number of Vδ1 increased in glioblastoma with overexpression of CD16, CD56, and NKG2D. Our results showed that γδT cells are prone to adopt a pro-inflammatory profile in the glioblastoma context, which suggests that they might be a potential tool to consider in T cell-based immunotherapy in glioblastoma. However, this requires additional investigation on a larger sample size.

Ruptured intraventricular tuberculous brain abscess mimicking cystic neoplasm: a case report.

Central nervous system (CNS) tuberculosis is a potentially life-threatening condition that may manifest in different forms and simulate other pathologies. It rarely involves the ventricles and the occurrence of primary intraventricular tuberculous brain abscess (TBA) has exceptionally been reported. As far as we know, ruptured intraventricular TBA has not been described before. An immunocompetent 56-years-old man was admitted for sub-acute intracranial hypertension with behaviour disorders. Cranial magnetic resonance imaging (MRI) showed a cystic lesion of the third ventricle containing fluid-fluid level with biventricular hydrocephalus and debris in the occipital horns. A ruptured cystic neoplasm was first considered. The patient underwent surgery via a right transcortical transventricular approach, combining both microscope and endoscope. The puncture of the lesion brought pus and the Ziehl-Neelson (ZN) staining demonstrated acid-fast bacilli. Intraventricular tuberculous abscess is an extremely rare condition that can take an unusual radiological appearance. This observation highlights the consideration of tuberculosis within the list of differential diagnosis of intraventricular cystic lesions in immunocompetent hosts.

Unusual association of COVID-19, pulmonary tuberculosis and human immunodeficiency virus, having progressed favorably under treatment with chloroquine and rifampin.

Infection with the new coronavirus has been declared an international health emergency. Its curative treatment is unknown and is the subject of several clinical trials. In addition, the concomitant association of COVID-19 with tuberculosis and the human immunodeficiency virus, hitherto never described, is potentially fatal. We report the illustrative case of a 32-year-old patient who presented this trifecta of infections and who did well under treatment with chloroquine and anti-mycobacterial drugs. This patient arrived at the ER with respiratory discomfort that had been evolving over a month with symptoms of flu and deterioration of her general condition. A chest CT scan revealed an aspect of lung miliary tuberculosis with isolation of Koch's bacilli in the sputum. A polymerization chain reaction (PCR) was positive for COVID-19 on a nasopharyngeal swab. HIV serology was positive. The course was marked by a spectacular clinical improvement and two negative COVID-19 PCR controls at the end of treatment (at days 9 and 10). Anti-tubercular drugs (especially, rifampin) are powerful enzyme inducers that can reduce the effectiveness of chloroquine in our patient. This therapeutic success may be linked to the effect of anti-tubercular drugs against SARS ncov-2, especially rifampin, inhibiting the formation of messenger RNAs of SARS ncov-2 or to the synergistic effect of chloroquine and rifampin. Researchers should explore the effect of these drugs on SARS ncov-2.

Diagnosis and management of intracranial tuberculomas: about 2 cases and a review of the literature.

Central nervous system tuberculosis is a major cause of morbidity and mortality in developing countries. Intracranial tuberculoma is rare and is one of the most severe cases of tuberculosis. We present two cases. The first one is about a girl of 7 years, followed for 5 months for lymph nodes tuberculosis on anti-TB treatment that presents generalized tonic-clonic seizures associated with progressive intracranial hypertension syndrome. Brain MRI has objectified necrotic nodules in left hemisphere. The surgical approach of the lesions was direct with complete excision. The diagnosis of tuberculoma was confirmed by anatomopathological examination. The second case is about a 6-year-old girl with no particular medical history, which presents for three months progressive and treatment-resistant cervico-occipital headaches associated with walking difficulties. The MRI objectified left cerebellar tumor process interpreted preoperatively as medulloblastoma. The patient was operated on intraoperative, appearance was that of a nodular lesion. Anatomopathological examination confirmed the diagnosis. The intracranial tuberculoma is an unusual variety of the central nervous system tuberculosis and remains a topical issue in Morocco. The prognosis depends on prompt diagnosis, quality of surgical resection and anti-TB treatment. The diagnostic confirmation is histological and should therefore be evoked infront of any intracranial process mimicking a brain tumor.

[Brain tumors in children: about 136 cases]. / Tumeurs cérébrales de l'enfant: à propos de 136 cas.

Brain tumors are the most diagnosed solid tumors in children under the age of 15 years worldwide. However, the epidemiological and anatomopathological profile of these tumors has been poorly described in African and, particularly, in Moroccan literature. This study highlights the epidemiological and anatomopathological peculiarities of primary brain tumors in children living in the region of Marrakech (south Morocco). We conducted a retrospective study in the Division of Anatomic Pathology at the Mohammed VI University Hospital, Marrakech from 2004 to 2016. One hundred and thirty-six patients were diagnosed with primary brain tumor, a mean of 11.33 cases per year. The average age of patients was 8.28 years. Sex-ratio (M/F) was 1.6 with a slight male predominance. Infratentorial tumors were found in 61,53% of cases while supratentorial tumors were found in 38.47% of cases. Infratentorial tumors mainly occurred in the cerebellar hemisphere (61.4%). Eighteen histological types were diagnosed. Astrocytoma and medulloblastoma accounted for 46,32% (29.41% and 16.91%, respectively). In our context, the majority of brain tumors in children was predominant in both age groups: 5-9 years and 10-15 years. The epidemiological data of these tumors from south Morocco are mostly consistent with those already published in North Country's literature and in other non-african countries' literature.

[Central neurocytomas: clinical and radiopathological correlations: about 12 cases]. / Neurocytomes centraux: corrélations cliniques et radiopathologiques à propos de 12 observations.

Central neurocytomas are defined as neoplasms composed of round, uniform cells, with neural immunophenotypic profile and low proliferation index. They account for 0.5% of intracranial tumors. They usually occur near the foramen of Monro and can cause obstructive hydrocephaly. We conducted a retrospective data collection from records of 12 patients with central neurocytomas in the Anatomopathological Laboratory at the Mohammed VI University Hospital, Marrakech, between January 2006 and June 2015. This study aimed to report and describe the radiopathological features of this rare histologic type. The male/female sex-ratio was 1.4. The average age at diagnosis was 22.3 years. The revealing symptomatology was dominated by intracranial hypertension associated with decreased visual acuity and diplopia in all patients. Our study concerned about simple biopsy in one case, subtotal resection in seven cases and total resection in four cases. Histopathological examination showed tumor proliferation with endocrine architecture. Tumor cells are more often small and uniform. Mitotic index was low. Tumor proliferation was associated with fibrillary fundus and vascular network with three types of trees. Immunohistochemical examination was identical in all patients. It showed tumor cells positive for anti-synaptophysin antibodies, chromogranine and NSE. In all patients the radio-pathologic correlation suggested central neurocytoma (grade II - WHO 2016). This study highlights the anatomo-clinical, radiological and evolutionary features of these rare tumors.

Foramen magnum meningioma's management: the experience of the department of neurosurgery in Marrakesh.

Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (100%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer.

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.

Diagnostic and management of pediatric brain stem abscess, a case-based update.

PURPOSE: Authors report their experience of a pediatric brain stem abscess with a literature review. METHODS: A 2.5-year-old girl first displayed bacterial otitis 3 months before admission. Diagnosis of brain stem abscess was delayed, despite plethoric neurological signs. She complained of right hemiparesis, headache, squint, dysphagia, and false way inhalation pneumopathy. Brain magnetic resonance imaging revealed presence of an abscess in the pons, prompting for a microsurgical pus aspiration. Postoperative course was regular with a total neurological recovery. Clinical and radiological screening showed progressive regression of the pontine lesion after 4 months, despite persistence of a mild contrast enhancement. Present case is the 18th pediatric brain stem abscess reported in literature. RESULTS: Mean age of occurrence is 8.1 ± 4 years (range 0.75-16) without gender predominance. High morbidity is typical and essentially involves motor functions. The most common clinical signs are raised intracranial pressure, motor limbs deficit, and cranial nerve palsies. Fever was found in 10 out of 18 cases (56%). Three patients received conservative medical treatment. Three patients underwent stereotactic aspiration and 12 others underwent microsurgical aspiration or excision. No mortality was reported since the eighties. However, morbidity is still high. CONCLUSION: High clinical index of suspicion is necessary to improve functional outcome. Stereotactic-guided or microsurgical aspiration are still good therapeutic options. The rarity of pediatric brain stem abscesses and the need of optimal management make this case-based update very peculiar.

Primary liposarcoma of the lumbar spine.

BACKGROUND: We describe a rare case of the cauda equina syndrome caused by a primary pleomorphic liposarcoma of the lumbar spine. CASE REPORT: A 35-year-old man presented a 2-month history of back pain and slowly progressive weakness of lower limbs without sphincter dysfunction. It had a laminectomy for a supposed disc herniation three years previously. A diagnosis of recurrence hernia or fibrosis was discussed. RESULTS: Magnetic Resonance Imaging (MRI) and CT scan of the lumbar vertebral column shows diffuse involvement of L4/L5 vertebral bodies, and an intradural lesion surrounding the nerve roots of cauda equina. The tumor occupied almost the whole width of the spinal canal. The diagnosis of plasmocytoma or metastasis was advocated and the patient was managed by an extended posterior approach in emergency. Histopathological findings revealed a pleomorphic liposarcoma. The patient received a course of radiotherapy and unfortunately he died at 3 months follow-up. CONCLUSION: In spite of his unusual location in the spine, pleomorphic liposarcoma should be considered in the differential diagnosis of primary spinal tumors.