Posterior reversible encephalopathy syndrome: A case report.

Posterior Reversible Encephalopathy Syndrome (PRES) is a radio-clinical entity associating reversible damage of the central nervous system and typical brain imaging. The clinical context is often suggestive with, in half of cases, the use of vasoactive substances (cannabis, antidepressants, nasal decongestants) and/or postpartum. The etiologies are dominated by hypertensive encephalopathy, preeclampsia, eclampsia, immunosuppressive therapies, and systemic diseases. We report a case of posterior encephalopathy syndrome occurring in a young female without hypertension. It was about a 40-year-old female without hypertension underlying condition, received at the emergency department for headaches and generalized tonic-clonic seizures. The physical examination was unremarkable, and her blood pressure was 130/70 mm Hg. CT scan revealed bilateral white matter hypodensity in the posterior occipital regions and a right frontal subarachnoid hemorrhage. There was no aneurysmal malformation of the polygon of Willis and no cerebral thrombophlebitis. Brain MRI showed T2 and FLAIR hypersignal areas in the occipital and frontal cortico-subcortical regions, with no diffusion signal abnormalities or contrast enhancement, and a right frontal subarachnoid hemorrhagic lesion with no other impairment. The diagnosis of reversible posterior encephalopathy syndrome was made up, and the outcome was favorable under treatment. Posterior reversible encephalopathy syndrome is an uncommon but probably underdiagnosed condition. Hypertensive encephalopathy is the most common etiology. However, there would be cases of PRES without hypertension as shown in this observation.

Hepatocellular carcinoma surveillance among people living with hepatitis B in Senegal (SEN-B): insights from a prospective cohort study.

BACKGROUND: Chronic hepatitis B virus (HBV) infection is the predominant cause of hepatocellular carcinoma in west Africa, yet data on the incidence of HBV-related hepatocellular carcinoma remain scarce. We aimed to describe the uptake and early outcomes of systematic ultrasound-based hepatocellular carcinoma screening in SEN-B, which is a prospective HBV cohort in Senegal. METHODS: In this prospective cohort study, we included treatment-naive, HBsAg-positive individuals who were referred to the two infectious diseases clinics (the Department of Tropical and Infectious Diseases and Ambulatory Treatment Center) at Fann University Hospital of Dakar, Senegal, between Oct 1, 2019, and Oct 31, 2022. All participants resided within the Dakar region. Participants underwent abdominal ultrasound, transient elastography, and clinical and virological assessments at inclusion and every 6 months. Liver lesions at least 1 cm in diameter on ultrasound were assessed using four-phase CT, MRI, or liver biopsy. Adherence to hepatocellular carcinoma surveillance was measured using the proportion of time covered, calculated by dividing the cumulative months covered by abdominal ultrasound examinations by the overall follow-up time, defined as the number of months from the date of cohort entry until the last recorded visit, hepatocellular carcinoma diagnosis, or death. Optimal adherence was defined as a proportion of time covered of 100%. FINDINGS: Overall, 755 (99·6%) of 758 participants had at least one abdominal ultrasound performed. The median age of the enrolled participants was 31 years (IQR 25-39), 355 (47·0%) of 755 participants were women, and 82 (10·9%) had a family history of hepatocellular carcinoma. 15 (2·0%) of 755 individuals were HBeAg positive, 206 (27·3%) of 755 individuals had HBV DNA of more than 2000 IU/mL, and 27 (3·6%) of 755 had elastography-defined liver cirrhosis. Of ten (1·3%) participants with a focal lesion at least 1 cm at initial assessment, CT or MRI ruled out hepatocellular carcinoma in nine, whereas imaging and subsequent liver biopsy confirmed one patient with hepatocellular carcinoma. Two further patients with hepatocellular carcinoma were diagnosed at study presentation due to the presence of portal thrombosis on ultrasound. Excluding the three participants with hepatocellular carcinoma identified at baseline, 752 participants were eligible for screening every 6 months. Median follow-up time was 12 months (IQR 6-18) and the median number of ultrasounds per patient was 3 (2-4). During 809·5 person-years of follow-up, one incident hepatocellular carcinoma was reported, resulting in an incidence rate of 1·24 cases per 1000 person-years (95% CI 0·18-8·80). Overall, 702 (93·0%) of 755 participants showed optimal hepatocellular carcinoma surveillance, but this proportion decreased to 77·8% (42 of 54 participants) after 24 months. INTERPRETATION: Hepatocellular carcinoma screening is feasible in HBV research cohorts in west Africa, but its longer-term acceptability needs to be evaluated. Long-term hepatocellular carcinoma incidence data are crucial for shaping tailored screening recommendations. FUNDING: Swiss National Science Foundation, the Swiss Cancer Research Foundation, the National Cancer Institute, and Roche Diagnostics. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.

Early stage of cerebral amyloid angiopathy revealed by follow-up of a minimal head injury.

Cerebral amyloid angiopathy (CAA) is an age-related cerebral microangiopathy characterized by the accumulation of amyloid-beta peptide in the wall of leptomeningeal arteries and cortical vessels. Diagnosis of sporadic amyloid angiopathy is most often made in elderly patient with lobar hematoma. We report a case of a 68-year-old female who had minimal head injury. Cerebral CT showed a right cerebellar hematoma. Follow-up MRI after 4 months showed signs of cerebral amyloid angiopathy. Through this observation, we describe the MRI semiology that helps make the diagnosis of cerebral amyloid angiopathy.

Interest of preoperative embolization of aneurysmal bone cyst (ABC): A case report.

Aneurysmal bone cyst (ABC) is a rare lesion that primarily affects young adults and children. The optimal treatment approach for ABC remains controversial and varies depending on the preferences of the medical team. While some advocate for surgery as the treatment of choice, others recommend a less invasive first-line option such as selective embolization. In this case report, we present the case of a 41-year-old female patient with an ABC in the right iliac bone who underwent surgical treatment following preoperative selective embolization. Additionally, we provide a literature review on the topic.

Case report of a lithopedion of tubal location, in a young woman.

Lithopedion is a rare situation, corresponding to an ectopic pregnancy which evolves beyond the first trimester toward death and fetal calcification. This ectopic pregnancy is most often abdominal in location. Through this case report, we report the case of a lithopedion of left tubal localization in a young woman, diagnosed on CT scan following abdominal pain and confirmed by laparotomy with excision.

Safety and Quality of Milk and Milk Products in Senegal-A Review.

Historically, local milk production in Senegal has struggled to keep up with the demands of consumers, so there has been a heavy reliance on imported milk and milk products. More recently, efforts have been made to improve local dairy production by establishing large, organized dairies that collect milk from rural production areas and developing small-scale processing units, such as mini dairies. The local dairy value chain in Senegal consists of (1) informal collection systems where farmers commonly deliver milk directly to dairies; (2) traditional and artisanal processing using simple equipment and techniques; and (3) short local marketing and sale circuits. Most West African dairy sectors are dominated by raw, unpasteurized milk or traditional, spontaneously fermented milk products, such as lait caillé in Senegal, sold through small-scale channels without a cold chain, so the risk of food safety hazards may be increased. Microbiological, chemical, and physical hazards have been found in milk and milk products across West Africa. There is a need to educate milk producers, small-scale processors, and vendors on the importance of refrigerating milk immediately after milking as well as maintaining the cold chain until the milk is heat treated and, subsequently, until the milk is marketed to the consumer. However, without assistance, obtaining the equipment necessary for cold storage and processing of milk can be challenging.

Ischemic Stroke and Ruptured Mycotic Aneurysm, Two Complications of Infective Endocarditis in One Patient.

The incidence of infective endocarditis is estimated to be around 30 cases per million inhabitants/year. It can be responsible for various neurological complications such as cerebral infarction, meningitis, cerebral abscesses, and cerebral hemorrhage due to ruptured mycotic aneurysms. Several germs have been incriminated in this condition including Staphylococcus, Streptococcus, and Enterococcus. We report the case of a 64-year-old patient who presented with an acute motor deficit of the left upper limb associated with dysarthria. MRI showed infarcts in both cerebral hemispheres, and the TOF sequence showed an amputation of M2. On transesophageal ultrasound, there was evidence of vegetations at the mitral valve. Blood culture isolated Streptococcus oralis. With antibiotic treatment, the evolution was marked by a stable apyrexia with regression of the dysarthria. Before her surgery, she suddenly developed aphasia with worsening of the motor deficit. CT scan showed a right fronto-parietal hematoma which was related to a ruptured cerebral aneurysm. She underwent endovascular embolisation and subsequent cardiac surgery.

"Worm within worm": acute appendicitis containing an adult Ascaris lumbricoïdes.

Appendicitis is the first etiology for abdominal surgical emergency. Ascariasis is the most common helminth infection in tropical countries where it is endemic. The ability of intestinal helminths to wander through the digestive system means that it can end up in the appendix lumen and lead to appendicitis by luminal obstruction. However, this presentation is still rarely described in the literature. In fact, most of the diagnoses of roundworm associated with appendicitis are made retrospectively by the discovery of its eggs on the pathological examination of an appendectomy specimen. We report the case of a 7-year-old patient living in a tropical area who consulted for acute right lower quadrant pain. The ultrasound suspected the diagnosis of appendicitis and also revealed multiple intestinal worms including one in contact with the inflamed appendix. Surgical exploration confirmed appendicitis associated with roundworm partly in the appendicular lumen through a perforation.

Cervicofacial Cellulitis due to Staphylococcus aureus with Jugular Vein Thrombosis and Multiple Septic Pulmonary Embolism: A Lemierre-Like Syndrome.

This is the case of a 28-year-old male patient with no particular pathological history who presented with an inflammatory swelling of the right cheek with pus in an infectious context. Cervicofacial CT with contrast injection allowed the diagnosis of a right cervicofacial cellulitis, associated with a jugular venous thrombosis extending to the superior vena cava. It also revealed septic pulmonary metastases in the form of multiple excavated pulmonary nodules. The analysis of the pus sample allowed the isolation of Staphylococcus aureus as the causative germ. This led to the diagnosis of a Lemierre-like syndrome, which is a variant of the Lemierre syndrome. Despite appropriate antibiotic treatment and anticoagulation, the patient died after 16 days of hospitalization.

Epidermoid cyst of the cerebellar vermis: Case report of a rare medial topography.

Intracranial epidermoid cysts are very rare benign tumors representing less than 2% of intracranial tumors. They are located preferentially in the cerebellopontine angles, parasellar, and temporal regions. We report here the case of an epidermoid cyst of very uncommon medial location in the cerebellar vermis, in a 61-year-old female patient complicated with tumor protrusion into the foramen magnum and active hydrocephalus.

Rupture of an aneurysm of the gastroduodenal artery mimicking a tumor of the head of the pancreas in a case report.

Gastroduodenal artery aneurysms have a low incidence of less than 1.5% of all splanchnic aneurysms. Rupture is frequent and life-threatening. The diagnosis is made by CT scan and by coeliac angiography, which also plays a therapeutic role in stable or stabilized patients. Surgery remains the treatment of choice in case of hemodynamic instability. We reviewed the case of a ruptured aneurysm of the gastroduodenal artery mimicking a tumor of the pancreas' head in a patient who died following a hemorrhagic shock.

Malrotation of an iliac ectopic kidney with pyelo-ureteral duplication: An incidental three-in-one congenital anomaly.

Renal ectopia is a rare congenital anomaly that mostly occurs in the pelvic area. An ectopic kidney is usually associated with other anomalies such as a malrotation. We report the case of a 15-year-old male who consulted after a blunt abdominal trauma. A left iliac renal ectopia was incidentally discovered. This ectopic kidney was associated with a malrotation, and a pyelo-ureteral duplication. Iliac renal ectopia should be dissociated from other abdominal renal ectopias, and its association with other renal malformations should be further investigated.

Sturge Weber syndrome, when brain CT is enough for diagnosis: about a case.

One of the main manifestations of Sturge Weber syndrome is seizures. We report the case of a child received in the context of generalized seizures and in whom a cerebral contrast CT was sufficient to make the diagnosis of Sturge Weber syndrome.

False ground-glass opacity and suspicion of COVID-19, beware of the technique for performing the CT.

Ground-glass opacity is a CT sign that is currently experiencing renewed interest since it is very common in patients with COVID-19. However, this sign is not specific to any disease. Besides, the possibility of false positive ground-glass opacity related to insufficient inspiration during the acquisition of the chest CT should be known. We report the case of a 36-year-old patient suspected of COVID-19 and in whom a second acquisition of chest CT was necessary to remove false ground-glass opacities that erroneously supported the diagnosis of COVID-19.

Late diagnosis of imperforate hymen with hematometrocolpos and bilateral hydronephrosis of a horseshoe kidney.

Imperforate hymen is a fairly uncommon genital disorder where the hymen completely obstructs the vaginal opening. Several authors have ruled out its co-occurrence with other congenital anomalies. In this report, we discuss the exceptional case of a late diagnosis of imperforate hymen associated with bilateral hydronephrosis of a horseshoe kidney in a 19-year-old female patient. To our knowledge, an association of imperforate hymen and horseshoe kidney has never been reported.

Un cas de COVID-19 compliqué d´embolie avec deux tests PCR initialement négatifs malgré des signes scanographiques.

La maladie à coronavirus 2019 (COVID-19) déclarée en Chine en fin 2019 s´est rapidement généralisée aux autres continents. Son diagnostic se fait par test PCR (Polymerase Chain Reaction) sur des prélèvements naso-pharyngés. Ce test bien que spécifique est d´une sensibilité moindre comparé à la TDM thoracique. Nous rapportons le cas d´un patient testé négatif à deux reprises et chez qui la TDM retrouvait des signes typiques de COVID-19 et une embolie pulmonaire. Et ce n´est qu´après un troisième test PCR qu´il a été positif. Ce qui montre l´intérêt de répéter plusieurs fois les tests PCR mais également de considérer les signes scanographiques comme argument diagnostic devant induire une prise en charge adéquate.

[Sorting and detection of COVID-19 by low-dose thoracic CT scan in patients consulting the radiology department of Fann hospital (Dakar-Senegal)]. / Tri et détection du COVID-19 par TDM thoracique low-dose chez des patients tout-venant au service de radiologie de l´hôpital de Fann (Dakar-Sénégal).

INTRODUCTION: COVID-19 has spread rapidly since its emergence in China and is currently a global health issue. Its definitive diagnosis is made by PCR on nasopharyngeal swabs. However, this diagnostic test has low sensitivity with delayed results. Hence, thoracic computed tomography represents an interesting alternative. The aims of this study were to assess the frequency of computed tomography (CT) lesions suggestive of COVID-19 and to compare the results of CT and PCR test. METHODS: a prospective study carried out over15 working days and involved 47 patients. These patients were recruited based on the presence of at least 2 clinical signs of COVID-19. Chest CT without contrast according to the "LOW-DOSE" protocol was performed. A PCR test on nasopharyngeal swabs was done in patients with signs suggestive of COVID on CT. A serological test was performed in case of a discrepancy between the CT and PCR results. RESULTS: thoracic CT was abnormal in 38 patients and normal in 9 patients. Lesions suggestive of COVID-19 have been identified in 32 patients. Two patients had lesions of non-specific pneumonia. Tuberculosis lesions were visualized in 3 patients. One patient had lesions of interstitial pneumonia. The mean DLP was 59 mGy.cm with extremes of 25 and 95 mGy.cm. Ground-glass opacity was present in 100% of COVID-19 suspects on CT. The results of the PCR test were the same than CT in 12 patients. The positive predictive value for CT was 37.5%. In 20 patients with COVID lesions on CT, the PCR test was negative with a false positive rate of 62.5%. In the patients with negative PCR test, 4 had a serological test for COVID-19 and this test was positive in 3. CONCLUSION: low-dose chest CT can reduce radiation exposure in COVID-19 patients who are at risk of cumulative dose due to repetitive exam. CT can identify lesions suggestive of COVID-19. It also enables the triage of patients by identifying other diagnoses.

False ground-glass opacity and suspicion of COVID-19, beware of the technique for performing the CT

Ground-glass opacity is a CT sign that is currently experiencing renewed interest since it is very common in patients with COVID-19. However, this sign is not specific to any disease. Besides, the possibility of false positive ground-glass opacity related to insufficient inspiration during the acquisition of the chest CT should be known. We report the case of a 36-year-old patient suspected of COVID-19 and in whom a second acquisition of chest CT was necessary to remove false ground-glass opacities that erroneously supported the diagnosis of COVID-19