ABSTRACT
BACKGROUND: Hydatid disease is a parasitic infestation caused by Echinococcus granulosus, affecting both children and adults. Its intracranial form is extremely uncommon and can present a diagnostic and therapeutic challenge. PURPOSE: To analyze the clinical manifestations, radiological features and surgical outcomes in 21 pediatric patients with intracranial hydatidosis and to share our experience managing this pathology, with a review of relevant literature. PATIENTS AND METHODS: We report a case series of 21 pediatric patients operated on for intracranial hydatid cyst in the neurosurgical department of Ibn Tofail Hospital, Mohammed VI University Hospital, Marrakech, Morocco, between January 2012 and December 2019. We performed a comparison of our results with results from 18 case series in a review of the literature. RESULTS: The most common presenting symptom was intracranial hypertension, followed by neurological deficit. Other symptoms included visual impairment, cranial nerve palsy and seizures. A computed tomography scan confirmed the diagnosis in all patients. Serological analysis was positive in 5 patients, all of whom had an associated extracerebral location. All patients were operated on successfully using the Arana Iniguez technique. CONCLUSION: Intracranial hydatid disease should be suspected in case of intracranial hypertension in children and adolescents from endemic countries. The diagnosis is confirmed by head CT. Treatment is mainly surgical and prognosis is favorable. Prevention is the most effective way of addressing this disease and we therefore stress the importance of investing in population education and animal control.
Subject(s)
Brain Diseases , Central Nervous System Cysts , Echinococcosis , Intracranial Hypertension , Humans , Brain Diseases/complications , Echinococcosis/diagnosis , Echinococcosis/surgery , Tomography, X-Ray Computed , Intracranial Hypertension/surgery , Intracranial Hypertension/complications , Central Nervous System Cysts/complicationsABSTRACT
OBJECTIVE: To determine the severity factors in severe traumatic brain injuries. METHODS: A prospective descriptive study of severe head injuries admitted to the emergency department at Ibn Tofail Hospital at the University Hospital of Marrakech over a period of six months from May to October 2015. The following data was collected: circumstances, clinical, biology, radiology, treatment and evolution. RESULTS: One hundred and nineteen patients with severe traumatic brain injury were collected (101 males, 84,9%). The mean age was 37,73±15,7 years. Road accidents were the most common cause representing 84%. The median Glasgow coma scale (GCS) was 7±3. We noted 36 cases (30,3%) of anisocoria, 32 cases (26,9%) of bilateral mydriasis and 72 cases (60,5%) of hypoxia. Cerebral contusions (66,1%) and meningeal hemorrhage (66,6%) were the most frequent lesions on CT. Forty-seven patients (42%) had stage VI Marshall lesions. Twenty-four patients (20.1%) required a neurosurgical intervention, 12 extradural hematoma evacuations and 10 craniocerebral wounds. Mortality was 64.7% (77 deaths), the main cause was neurological (64,9%). In the latter group, we observed more frequently an older age (P=0.00001), a management delay (P=0.011), a low initial GCS (P=0.000001), a bilateral nonreactive mydriasis (P=0.0001), a hypoxia (P=0.0002), a subarachnoid hemorrhage (P=0.008), a high Marshall score (P=0.017) and an anemia (P=0.046). CONCLUSION: Head trauma is a public health problem. The victims are young, and the sequelae are frequently disabling. Several parameters are associated with a poorer prognosis including age, neurological state and the initial delay in management.
