RESUMO
Cavernous hemangiomas are vascular malformations that can affect any part of the central nervous system. In general, epidural hemangiomas are secondary extensions of spinal lesions. These tumors grow slowly and are expressed as slow spinal cord compression syndromes, radiculopathy, or both. History, clinical examination, routine radiographs, MRI, and histopathologic studies are aids to a definitive diagnosis. This is a 61-year-old chronic smoker with a history of cholecystectomy in 2017. History of the disease: dates to 1 month by a progressive installation of heaviness of the left lower limb, then of the right one 15 days later. The state was complicated one week before his admission by sphincter disorders such as urinary leakage. Clinically, the patient walked with assistance, with a paraparesis of the two lower limbs at 4/5 on muscle testing, with a posterior cord syndrome, a D6 sensory level and normal osteotendinous reflexes. Spinal cord MRI showed a tissue-like process at D6-D7 extra-medullary extradural. Spinal cavernous extradural hemangioma is a frequent lesion, represented by a malformation of the microcirculation, whose diagnosis has become easier with the advent of MRI, revealed essentially by a spinal cord compression syndrome, whose evolution is favorable if treated in time.
RESUMO
Kernohan Woltman Notch Phenomenon (KWNP) is caused by a supratentorial lesion pressing the contralateral cerebral peduncle against the free edge of the tentorium of the cerebellum. It is manifested by neurological signs of ipsilateral localization; cerebral MRI is the most sensitive examination for KWNP. Our patient is a 50-year-old woman, operated in 2011 for aortic and mitral valve replacement by mechanical prosthesis, under oral anticoagulant, consults for headaches evolving for 20 days without any notion of head trauma with installation of a progressively worsening left hemibody deficit. Glasgow coma scale was 14 (E3 V5 M6) with left anisocoria 4mm left/2mm right with left hemiplegia. CT shows a chronic left hemispheric subdural hematoma 13.5mm thick with subfalcorial and ipsilateral temporal involvement of the deficit. The cardiovascular examination as well as the biological assessment was unremarkable. The patient was operated on with a total recovery in 12 days, the anticoagulant is resumed on day 20 postoperatively, with close monitoring. KWNP may contribute to misdiagnosis in patients with bilateral corticospinal tract lesions, and anticoagulation poses a problem in stopping and restarting treatment due to the risk of bleeding on one side and thrombosis on the other side.
RESUMO
Primary Dural lymphoma (PDL) is a rare pathology that occurs in immunocompetent patients. In such cases, these lesions may mimic more common intracranial tumors. We present the case of a patient who presented an intra cranial hypertension syndrome; the brain MRI showed a tissular mass that we took for a meningioma; upon surgical intervention, an occult mass was discovered. Major excision and immunohistochemistry demonstrated PDL. Our case report highlights the rarity of these pathology and the importance of combined surgery and medical treatment, as the latter can be treated with chemoradiation with good clinical outcomes.
RESUMO
Cerebral hydatid cyst is rare (2%), and mainly affects children. We report 2 cases aged 5 years. The clinical symptomatology was dominated by intracranial hypertension syndrome and motor deficit in both cases. One patient presented a generalized tonic-clonic seizure, the second one presented a left central facial palsy. The diagnosis was made in both cases by brain CT scan and one patient underwent brain MRI. A radiological workup to look for extra-cerebral localization was performed for all patients, which was normal. The treatment was surgical for both patients (D'ARANA-INIGUEZ hydro pulsion technique) with simple after-effects. The postoperative CT scan showed a residual cavity. All our patients were put under antiparasitic treatment with Albendazole.
