Mild Encephalopathy/Encephalitis With Reversible Splenial Lesion Associated With Meningitis Related to Mumps Disease: An Unusual Presentation in a Male Adult.

Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) is characterized by mild neurological manifestations associated with spontaneously reversible lesions of the splenium of the corpus callosum. While various conditions and diseases can trigger MERS, infectious causes predominate, with mumps being notably linked to MERS in the pediatric population. Although rare in adults, there are sporadic case reports associating mumps with MERS. Here we report a 23-year-old male patient with a typical presentation of mumps who presented with meningeal syndrome, dizziness, seizures, and right orchitis. Brain MRI showed classic findings of MERS syndrome while cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis. Our patient had a confirmed diagnosis of mumps disease with multiple complications, including MERS, meningitis, and orchitis, and was managed with symptomatic medications and antiviral therapy. Subsequently, there was a gradual resolution of these manifestations and the outcome was favorable, with no residual sequelae.

Hypoglycemic encephalopathy with extensive brain injuries: A case report.

Hypoglycemia is known as a sudden diminution in blood glucose level <50 mg/dL. Hypoglycemic encephalopathy is a metabolic encephalopathy that is usually observed in patients treated for diabetes or chronic alcoholism. Neurological manifestations may range from transient deficits to prolonged coma, depending on the duration and severity of hypoglycemia. Neuroradiological features of hypoglycemia are variable involving the cerebral white and gray matter regions. Acquired metabolic or toxic conditions can cause hypoglycemia-like damage to the cerebral white matter and basal ganglia. Widespread lesions in the brain parenchyma or basal ganglia have a poor prognosis. In this report, we present a patient with widespread brain damage secondary to profound and prolonged hypoglycemia.

Hyperbaric oxygen therapy in carbon monoxide poisoning in Moroccan patients.

Describe the epidemiological, clinical characteristics of acute carbon monoxide poisoning (COP), and the therapeutic effect of hyperbaric oxygen therapy on patient's clinical outcome. This is the first study in this field in Morocco. It studies retrospectively 309 victims of acute COP with major neurological signs. All patients have been treated with hyperbaric oxygen therapy, and have been admitted by the emergency department of the Mohammed V military training hospital in Rabat, between January 2015 and December 2018. All poisonings were accidental and occurred especially in winter (50%), with a predominance in urban areas (93%). The poisoning was often caused by a non-compliant water heater (91%), multi-causality was in half of the cases, and affected adults and women (mean age: 21 ± 17 years, gender (male:female) 1:1.5. The average admission time to the hyperbaric chamber lasted 9 h 04 min (± 12 h 32 min). Clinical signs were mainly unconsciousness (151 cases), headache (85 cases), vomiting (63 cases), nausea (53 cases), and dizziness (51 cases). All the patients benefitted from hyperbaric oxygen therapy sessions. The clinical outcome was positive in the majority of cases, but 23% of the cases presented minor or major sequelae. Patients with sequelae had a longer length of admission than those who had not. COP is a major public health problem in Morocco. Through this study, we suggest the interest of hyperbaric oxygen therapy, especially when it is administered timely without delay.

Neuromeningeal tuberculosis in HIV-negative patients: a retrospective study in Rabat, Morocco.

Neuro-Meningeal Tuberculosis (NMT) is a severe infection of the central nervous system which causes a public health problem in Morocco and in several countries in the world. In order to describe the epidemiological, clinical, paraclinical and outcome among NMT patients without HIV, we carried out a retrospective study at the neurology department of the Military Hospital of Rabat in Morocco, over a period of 17 years (2000-2017). Forty patients were included with a mean age of 44 years (± 18) and a sex ratio of 1.66. A history evoking the possibility of tuberculous origin was found in 8 patients (20%). Febrile confusion was the most common clinical manifestation and was observed in 22 patients (55%) followed by febrile meningeal syndrome in 12 patients (30%). The main abnormalities noted in brain magnetic resonance imaging (MRI) were: hydrocephalus in 13 cases (32.5%), intra-cranial tuberculomas in 10 patients (25%) and leptomeningitis in 9 cases (22.5%). Cerebrospinal fluid study found clear aspect in 29 patients (75%), direct acid fast bacilli smear examination was positive in 4 patients (10%) and positive culture in 4 patients (10%). The Polymerase chain reaction (PCR) study returned positive in 6 patients (35%) of the 17 patients tested. The outcome was good in 18 patients (45%) while 19 patients suffered from neurological sequelae (47.5%) and 3 cases of death recorded (7.5%). Febrile confusion was the most reported manifestation in our patients. Subacute onset of symptoms was the most predominant feature in our patients as reported in the literature. Our results are consistent with the literature and confirm the severity of this infectious disease, even in HIV-negative patients.

Neuro-Behçet's Disease With Coma.

Behçet's disease (BD) is a multisystemic vasculitis condition with unknown pathophysiology. Its clinical manifestations include recurrent oral and genital ulcers, cutaneous lesions, and uveitis. The term neuro-Behçet's disease (NBD) refers to the predominant neurological involvement in BD. The management of NBD is based on the severity of symptoms and the existence of additional systemic signs. Glucocorticoids and disease-modifying drugs are used for the treatment of the disease. In this report, we present a case of neuro-Behçet's disease (NBD) that presented with coma and extensive neuroradiological abnormalities.

Persistent aura and status migrainosus in CADASIL syndrome: A case report.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary microangiopathy characterized by a genetic predisposition to small arteries of the brain. It is produced by a mutation in the NOTCH3 gene and concerns adults. The symptomatology is diversified including migraines with or without aura, subcortical ischemic events, and cognitive impairment. The diagnosis of CADASIL is suspected by neuroimaging and confirmed by genetic testing. Treatment of the disease remains preventive. We report a case of CADASIL manifesting as status migrainosus with persistent aura.

Moyamoya syndrome presenting in an adult with Down syndrome: A case report with a literature review.

Moyamoya disease is an unusual occlusive cerebrovascular condition commonly seen in children, marked by stenosis of the internal carotid artery and circle of Willis, causing, cerebral ischemia. Moyamoya syndrome is a Moyamoya-like arteriopathy with risk factors including autoimmune disorders, thyroid disease, sickle cell disease, or Down syndrome. Trisomy 21 is a genetic disorder consistent with specific physical and behavioral characteristics, with intellectual impairment. We describe a rare case of Moyamoya syndrome manifesting as ischemic stroke in an adult with Down syndrome.

Dyke-Davidoff-Masson syndrome: A case report with a literature review.

Dyke-Davidoff-Masson syndrome (DDMS) is an uncommon neurological disease defined as cerebral hemiatrophy with a contralateral motor deficit, facial asymmetry, and seizures. Classic imaging findings are cerebral hypoplasia, ventriculomegaly, paranasal sinus hyper-pneumatization, and compensatory osseous enlargement. The diagnosis of DDMS is based on the correlation between clinical and neuroimaging features. The management of DDMS is based on anticonvulsant medication with physiotherapy. We describe an unusual case of DDMS presented with frequent and persistent seizures.

Chorea in Neuro-Behçet's Disease.

Behçet's disease (BD) was described as a multisystemic recurrent inflammatory disorder of unknown cause comprising uveitis, skin lesions, recurrent genital, and oral ulcers. Involvement of the central nervous system in BD is about 10-25%. Chorea is defined as a hyperkinetic movement disorder, which can be caused by different etiologies. It was rarely mentioned in the literature as a manifestation of neuro-Behçet's disease (NB). Radiological lesions are predominant in basal ganglia and periventricular white matter. The evolution of chorea in NB is variable in literature studies. We present a rare case of parenchymal NB with chorea.

[Management of cerebral radionecrosis: experience in the Department of Neurology at the Mohammed V Military Teaching Hospital]. / Prise en charge de la radionécrose cérébrale: expérience du Service de Neurologie de l'Hôpital Militaire d'Instruction Mohammed V.

Brain radionecrosis is a rare but life-threatening complication of external-beam radiotherapy for ENT cancers, in particular of the nasopharynx, and for brain tumors. Very few studies were conducted on this complication in the African population as well as in the Maghreb population. Therefore our study aims to describe the demographic, clinical, paraclinical, therapeutic and evolutionary features of cerebral radionecrosis in the Department of Neurology at the Mohammed V Military Teaching Hospital in Rabat over a period of 18 years (2000-2017). The study involved 4 women and 13 men, with an average age of 50 years. The mean time between the end of the radiotherapy and the onset of neurological signs was 28 months. Systematic Brain MRI, sometimes complemented by spectro-MRI, allowed the diagnosis in 100% of cases. Etiologically, this complication occurred after radiotherapy for nasopharyngeal carcinoma and cancer of the larynx in all cases. Fifteen patients were treated with a combination of: bolus application of corticosteroids, platelet aggregation inhibitors associated with hyperbaric oxygen therapy with good evolution of two patients in whom oxygen therapy was contraindicated due to a lung problem and ENT cancer, received a combination of bolus application of corticosteroids and platelet aggregation inhibitors with unchanged evolution. These results demonstrate the importance of early diagnosis in patients with potentially serious conditions, in particular neuropsychiatric conditions, as well as of treatment combining bolus application of corticosteroids and hyperbaric oxygen therapy because this is the best guarantee of a favorable outcome, without omitting the crucial role of preventive measures.

[Occipital condyle syndrome: the visible part of the iceberg]. / Le syndrome du condyle occipital: la partie visible de l'iceberg.

Occipital condyle syndrome is a rare clinical disorder, clinically defined by the association of intense occipital headaches and paralysis of the twelfth paired cranial nerve. Its etiology is dominated by metastatic tumor. Imaging is the gold standard for diagnosis allowing to highlight occipital condyle lesion as weel as to find out primary tumor. Treatment is based on pain relief using analgesics, corticosteroids and very often, external radiotherapy. On the other hand, treatment of metastatic tumor is based on cytotoxic chemotherapy, targeted therapies or immunotherapy depending on the molecular profile of the primary tumor.

Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Morocco.

Increased prevalence of latent tuberculosis infection (LTBI) has been observed among high-risk populations such as healthcare workers (HCWs). The results may depend on the method of LTBI assessment, interferon-gamma release assay (IGRA) and/or tuberculin skin test (TST). Here, we investigated the prevalence and risk factors for LTBI assessed by both IGRAs and TST in HCWs living in Morocco, a country with intermediate tuberculosis (TB) endemicity and high BCG vaccination coverage. HCWs were recruited in two Moroccan hospitals, Rabat and Meknes. All the participants underwent testing for LTBI by both IGRA (QuantiFERON-TB Gold In-Tube, QFT-GIT) and TST. Different combinations of IGRA and TST results defined the LTBI status. Risk factors associated with LTBI were investigated using a mixed-effect logistic regression model. The prevalence of LTBI among 631 HCWs (age range 18-60 years) varied from 40.7% (95%CI 36.9-44.5%) with QFT-GIT to 52% (95%CI 48.2-56.0%) with TST using a 10 mm cut-off. The highest agreement between QFT-GIT and TST (κ = 0.50; 95%CI 0.43-0.56) was observed with the 10 mm cut-off for a positive TST. For a definition of LTBI status using a double positive result for both QFT-GIT and TST, significant associations were found with the following risk factors: being male (OR = 2.21; 95%CI 1.40-3.49; p = 0.0007), belonging to age groups 35-44 years (OR = 2.43; 95%CI 1.45-4.06; p = 0.0007) and even more 45-60 years (OR = 4.81; 95%CI 2.72-8.52; p = 7.10-8), having a family history of TB (OR = 6.62; 95%CI 2.59-16.94; p = 8.10-5), and working at a pulmonology unit (OR = 3.64; 95%CI 1.44-9.23; p = 0.006). Smoking was associated with LTBI status when defined by a positive QFT-GIT result (OR = 1.89; 95%CI 1.12-3.21; p = 0.02). A high prevalence of LTBI was observed among HCWs in two Moroccan hospitals. Male gender, increased age, family history of TB, and working at a pulmonology unit were consistent risk factors associated with LTBI.

Severe pemphigoid gestationis associated with acute disseminated encephalomyelitis in the setting of a systemic disorder.

Pemphigoid gestationis is a skin-specific autoimmune disorder that can sometimes present as the cutaneous manifestation of a multiorgan disease due to potentially common pathogenic mechanisms. We report a severe form of pemphigoid gestationis in a 32-year-old primigravida woman, who presented at 22 weeks of gestation with headaches and blurred vision, later developing encephalitis, intrauterine fetal demise and dilated cardiomyopathy.

[Acute medullary infarct: a still little know diagnosis with a poor prognosis]. / Infarctus médullaire aigu: un diagnostic méconnu au pronostic sévère.

Medullary infarct is still little known influencing the short-term vital and functional prognosis of patients. Medullary vascularization is one of the most complex in the body due to the significant number of arteries that contribute to it. Our knowledge is still limited due to the scarcity of vascular medullary accidents and to low accessibility of medullary vessels during assessments. We report the case of a 62-year old patient with type 2 diabetes and a 13-year history of oral antidiabetic treatment who had been followed-up for psoriasis for 4 years. He presented to hospital in the night with his son due to acute onset of upper limb deficit. This deficit was preceded by acute onset of neck pain during his daily prayer. On admission, the patient was conscious, arterial pressure 120/86mmhg, heart rate 89 beat/min, afebrile. Clinical examination showed flaccid brachial diplegia. There was no sensory disorder or sphincteric disorder and cranial nerve examination was normal. Emergency medullary MRI was performed which showed T2 hyperintense signal and "snake-eyes"-like bilateral central dissemination (A and B). Etiological assessment showed therosclerotic patches at the origin of the left internal carotid artery. The diagnosis of myocardial infarct associated with medullary fibrocartilaginous embolism was retained. Functional rehabilitation was started early as well as treatment with platelet aggregation inhibiting drugs.

Erratum to: Severe Paraneoplastic Parkinsonism: A Rare Cause Revealing Breast Cancer.

This corrects the article on p. 310 in vol. 13, PMID: 28748681.

Brucellosis: A cause of meningitis not to neglect.

Brucellosis is the most frequent bacteria zoonosis in the world, with more than half a million new cases each year [1]. It is also the most significant zoonos in the edge of the Mediterranean Sea [2]. This zoonosis is capable of affecting humans and cause polymorphic clinical manifestations. In Morocco, the southern regions are the main affected areas [3]. We are reporting the observation of a 17-year-old male patient, who presented a febrile meningeal syndrome for 9 months without sensitivo-motor deficit. Tuberculosis is frequently evoked in such clinical presentations because Morocco is an endemic country, brucellosis is therefore often forgotten. The results of lumbar puncture, magnetic resonance imaging (MRI) and especially serology aided to conclude to a neuro-brucellosis. The outcome was favourable with antibiotic therapy.