Management of a recurrent stroke due to a carotid web.

Carotid web is a rare intraluminal parietal protrusion in the carotid artery. This vascular anomaly mostly occurs at the bifurcation causing turbulent flow, and is responsible of thrombi formation associated with embolic ischemic events. We report the case of a 35-year-old woman, with no medical history, who presented a recurrent middle cerebral artery (MCA) occlusion within twelve hours caused by a carotid bulb web. Although considered as a rare entity, carotid web is associated with the risk of recurrent strokes in the MCA territory and especially in the absence of the typically recognized risk factors. The key imaging is the CT angiography that shows the web, the cerebral artery occlusion, and the outcome appreciation. Therapeutic strategy associates antithrombotic treatment and operative management with stenting of the carotid web or endarterectomy.

Ischemic stroke secondary to radiation-induced carotid artery stenosis.

INTRODUCTION: Large vessel vasculopathy, such as carotid stenosis, has been shown to be a side effect of radiotherapy (RT) and has received increasing attention especially in recent decades with the improvement of RT technology. These injuries can lead to a higher risk of cerebrovascular events such as ischemic stroke. The management of these lesions may be performed with surgical repair but also with endovascular technique. OBSERVATION: A 61-year-old man was admitted to the emergency department for an acute ischemic stroke. He was treated 16years prior for laryngeal tumor for which he had received 23 sessions of radiation therapy at the dose of 60Gy per session. The CT scan showed a radiation-induced stenosis of the right internal carotid artery with thrombosis of the right anterior cerebral artery and the right middle cerebral artery. The patient was treated with angioplasty of the right internal carotid artery with good outcome. CONCLUSION: Radiation-induced vasculopathy of the carotid artery has gained relevance in patients with head and neck neoplasms. These vascular lesions are associated with the risk of late cerebrovascular events.

Recurrent floating common carotid artery thrombus related to COVID-19: A case report.

The occurrence of arterial and venous thrombosis during coronavirus infection has been widely reported since the beginning of the epidemic. Floating carotid thrombus (FCT) in the common carotid artery is exceptional and its main known cause is atherosclerosis. We describe the case of a 54-year-old man who developed, one week after the onset symptomatology of related to COVID-19 infection, an ischemic stroke, complicating a large intraluminal floating thrombus in the left common carotid artery. Despite surgery and anticoagulation, a local recurrence with other thrombotic complications occurred and the patient died.

Post-traumatic pseudoaneurysm of temporo-maxillary trunk in a child: A case report.

Post-traumatic pseudoaneurysm of branches of external carotid artery is very rare and is at high risk of engaging vital prognosis by a rupture, even more in child. So, it must be evoked in emergency in front of any beating mass after a local trauma. We report the case of a 14-year-old child with a pseudoaneurysm of the temporo-maxillary trunk that occurred after a local trauma. The diagnosis was based on clinical examination and angio-MRI. The treatment was hybrid. After an embolization of the arterial trunk we performed a surgical flattering of the pseudoaneurysm and suture of maxillary and temporal orifices.

A case report of inflammatory myofibroblastic tumor of cecum mimicking malignant wall thickening.

INTRODUCTION: Inflammatory myofibroblastic tumors (IMT) are an uncommon mesenchymal solid tumor commonly documented in children and young adults (Kim et al., 2012 [1]). Cecum is a rare location of this entity, may simulating a malignant tumor process. PRESENTATION OF CASE: A 71 year old patient was admitted for pain in the right iliac fossa with chronic constipation evolving for two months associated with weight loss. As a diagnosic step, an abdominal computed tomography (CT) scan was performed showing a thickening of the cecal wall. There was no regional or distant metastasis. During a colonoscopy, many biopsies have been returned to a non-specific chronic colitis; as a result, the IMT of the cecum was confirmed pathologically after ilio-coecal resection. DISCUSSION: IMT is difined as a solid mesenchymal tumor basically affects the soft parts as well as the visceral organs. The litterature show that frequent localisations are pulmonary and intra-orbital (Krzysztof Siemion et al., 23 February 2022); therefore, the cecal location is very rare may mimic a malignant tumor (Mauricio Gonzalez-Urquijo et al., January 20, 2020), It is worth recalling that the imaging outcomes are polymorphic and inconclusive; in addition, Surgical excision is the treatment of choice for IMT (Alireza Mirshemirani et al., Dec 2011) and the histopathology is still required for the final diagnosis. CONCLUSION: Radiologic features of IMT present a diagnostic challenge to the radiologist; also, mimic malignancy may lead to unnecessary investigations.

Unusual presentation of parotid gland adenoid cystic carcinoma : A case presentation and literature review.

Adenoid cystic carcinoma (ACC) represents approximately 10% of all epithelial salivary neoplasms and most commonly involves the parotid gland. We report CT and MRI finding of a 38-year-old young man presented to our ENT department with 02 years history of an external auditory canal stenosis. Physical examination revealed bilateral parotid gland swelling with a complete stenosis of the left external auditory canal. Temporal bone contrast enhanced CT-SCAN revealed is an isodense enhancing mass measuring 4 cm involving posterior and inferior external auditory canal wall, and invading the superficial lobe of the homolateral parotid gland. No bone erosion was noted. MRI investigation has shown a tumor process highly suspicious of malignancy centered on the left EAC involving the superficial lobe of the homolateral parotid gland. Adenoid cystic carcinoma (ACC) of the parotid gland was the final diagnosis, after surgical biopsy and histopathological examination. The Pre-operative check-up demonstrated multiple round shape lung lesions suggestive of multiple metastases. Considering the metastatic stage of the tumor, a collegial decision to adopt a palliative treatment approach based on chemotherapy was taken by the multidisciplinary oncology board.

Inflammatory myofibroblastic tumor of the spleen: a case report.

Inflammatory myofibroblastic tumors (IMTs), otherwise known as the inflammatory pseudotumor, is a rare solid mesenchymal tumor, simulating malignant neoplasms, histologically characterized by the proliferation of spindle cells in a fibrous myxoid stroma containing inflammatory cells. CT and MR imaging are the most used tools in their assessment. Clinical features are nonspecific and depend on the localization of the tumor, radiologic findings are polymorphic and no-conclusive and present a diagnostic challenge to the radiologist. Although histology remains obligatory for the final diagnosis. Heren, we report a case of splenic IMT with histological correlation.

Cerebral venous thrombosis during relapse of ulcerative colitis: Case report with review of literature.

Cerebral venous thrombosis (CVT) is a rare but serious complication of ulcerative colitis (UC) with a high morbidity and mortality rate. CVT is not usually readily recognized and treatment may be delayed, impacting on the prognosis. Here we are reporting 2 cases of CVT occurring during a relapse of ulcerative colitis (UC) with review of literature. The first patient was a 27-year-old woman with chronic UC who presented with headaches during a relapse of chronic UC. She was found to have cerebral venous sinus thrombosis. The second one was a 45-year-old man who presented with seizures and focal neurological symptom during a relapse of chronic UC. He was found to have cerebral venous sinus thrombosis complicated by left temporal infarction. Both of them were treated with therapeutic anticoagulation with good improvement. The presence of neurological signs in a patient with UC mostly during exacerbation period, should alert health professionals about the possibility of a CVT.

Acute abdomen in adult revealing unusual complicated epiploic appendagitis: A case report.

INTRODUCTION: Epiploic appendagitis is a torsion of fatty appendages of ligamentum trees (1), it's a rare cause of abdominal pain that usually manifests by right or left iliac fossa pain, reminding of appendicitis, diverticulitis or ischemia of the omentum. CASE PRESENTATION: We report the case of a 56 years old male patient admitted for an epigastric pain and a right-upper quadrant abdominal pain, for whom he underwent an abdominal ultrasound and a CT-scan who shown an abscessed mass under colic transverse to the unusual seat. DISCUSSION: CT scan is still the key modality for diagnosis, avoiding unnecessary surgery. Complications of primary epiploic appendagitis have rarely been described in the literature (Hwang et al., 2013; Hasbahceci et al., 2012). Another more rare complication is appendagitis with associated abscess, in this condition, we must also think about complicated diverticulitis. The treatment of uncomplicated forms is generally conservative, however, some authors have suggested a surgical method (Saad et al., 2014). For therapeutic management of its complication, there has been much interest in the use of minimally invasive techniques such as percutaneous drainage to minimize the morbidity and mortality that is associated with surgery (Evidence National Guideline Centre (UK), 2019). CONCLUSION: The diagnosis of epiploic appendagitis is still uncommon, CT scan can eliminate other diagnosis of acute abdominal pain such as diverticulitis and appendicitis. It also allows the diagnosis of the rare complicated forms such as abscesses associated with epiploic appendagitis. The treatment of typical forms is usually conservative, while the complicated form requires surgery because of the potential associated pathology.

Towards a large-scale integration of renewable energies in Morocco.

Renewable energies are a sustainable, unlimited and decarbonised solution to address future energy challenges. In this context, Morocco has a considerable advantage to position itself on this promising market. Furthermore, renewable energies have been highlighted as a key strategic source for the country's green growth. Morocco has adopted the renewable energy path through a strategy targeted on the development of solar, wind and hydroelectric power to boost its energy policy by adapting it to the challenges posed by today's world. Nowadays, Morocco is facing a challenge to reach 52% by 2030 of its total renewable energy capacity, which will exceed 42% by the end of 2020. The main objective of this paper is to study a scenario for 2030 for the Moroccan electricity system and to identify the challenges that need to be addressed in order to accelerate the integration of renewable energies in the Moroccan energy mix and to achieve a possible export of such green energy towards Europe.

[Cerebral venous thrombosis: Clinical and radiological features, about 62 cases]. / La thrombose veineuse cérébrale : aspects clinico-radiologiques, à propos d'une série de 62 cas.

The work's purpose is to make a general review on the various clinical-radiological aspects and the management of cerebral venous thrombosis (CVT) in our hospital and compare them to those described in the literature. MATERIAL AND METHOD: Our series included 62 patients aged over 18 years, collected over 7 years (2009-2016) in the radiology department of the CHU Hassan II of Fez (Morocco), in which the radiological diagnosis of TVC was retained. Our patients have benefited from a brain CT scan and brain MRI. Clinical and radiological characteristics and post-treatment progression were described. RESULTS: The average age was 35 years with a female predominance; sex ratio 3.76 (49F/13H). The symptomatology was non-specific, made mainly of headaches, comic crises, disturbances of consciousness and focal signs. The upper longitudinal sinus was dominant topography (51.61%). The etiological factors were varied: infectious (sinusitis, chronic otitis media, oto-mastoiditis, bacterial meningitis, and septicemia), gyneco-obstetrical (oral contraception, pregnancy, and postpartum), systemic (Behçet diseases, polycythemia of Vaquez, paraneoplastic syndrome, antiphospholipid syndrome), local (head trauma), undetermined etiological factors. The CT scan, but especially the cerebral MRI, made it possible to make the diagnosis but also to direct towards the etiology. CONCLUSION: Cerebral MRI is currently the best imaging in the diagnosis of CTV, allowing an accurate assessment of its location, extent and impact on the cerebral parenchyma. Multiple conditions are responsible for CTVs. Therapeutic management is based on heparinotherapy and etiological treatment.

[A jejunal artery pseudoaneurysm ruptured in the jejunal lumen: A rare vascular complication of severe pancreatitis]. / Faux anévrisme rompu d'une artériole jéjunale: une complication rare d'une pancréatite grave.

Jejunal pseudoaneurysm is a rare complication of pancreatitis, usually manifested by digestive bleeding when it ruptures into the digestive lumen. This complication is extremely rare and may be life-threatening. The diagnosis is based on abdominal angiographic computed tomography. Radiology allows therapeutic management through arterial embolization. This case report describes a pseudoaneurysm of jejunal artery that developed as the result of pancreatitis: A 77-year-old man seen in early September 2015 at the emergency department for acute pancreatitis had a pseudocyst infected and spontaneously fistulized into the jejunum lumen. His condition responded initially to symptomatic therapy, and he was discharged. He returned two years later, with digestive bleeding from jejunal pseudoaneurysm that had ruptured into the jejunal lumen. Angiographic embolization was performed as first-line treatment with good outcome. Bleeding more than two years after acute pancreatitis due to rupture of a jejunal pseudoaneurysm is an exceptional complication. Here we report a rare case of digestive hemorrhage caused by jejunal pseudoaneurysm, complicating acute pancreatitis.

Retroperitoneal Paraganglioma-Induced Cardiogenic Shock Rescued by Preoperative Arterial Embolization.

BACKGROUND: Catecholamine-induced cardiogenic shock is a rare manifestation of paragangliomas. The high mortality rate of this condition makes the immediate, multidisciplinary approach mandatory. CASE REPORT: We report a case of an 18-year-old woman with a retroperitoneal secreting paraganglioma, complicated with a cardiogenic shock and an acute adrenergic myocarditis, requiring hemodynamic support and emergency arterial embolization prior to surgical excision, with a favorable outcome. CONCLUSION: Paraganglioma-induced myocarditis is rare but can be dramatic. Management requires appropriate and immediate hemodynamic support. Embolization may be an alternative to stabilize the patient prior to surgery.

[Aorto-cava fistula complicating abdominal aorta aneurysm]. / Fistule aortocave compliquant un anévrisme de l'aorte-abdominale.

We report here a case of aorto-cava fistula complicating the rupture of a sub-renal aortic aneurysm into the inferior vena cava, which is a rare complication of aortic abdominal aneurysms with often-fatal outcome. Abdominal computed tomography with multi-planar reconstructions remains the firstline-imaging tool allowing positive diagnosis and preoperative planning. Treatment may be surgical or endovascular.

Assessment of hemodialysis impact by Polysulfone membrane on brain plasticity using BOLD-fMRI.

PURPOSE: Hemodialysis (HD) is considered the most common alternative for overcoming renal failure. Studies have shown the involvement of HD membrane in the genesis of oxidative stress (OS) which has a direct impact on the brain tissue and is expected to be involved in brain plasticity and also reorganization of brain function control. The goal of this paper was to demonstrate the sensitivity of the blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) to characterize the OS before and after the HD session. PATIENTS, MATERIALS AND METHODS: Twelve male patient-volunteers following chronic HD for more than 6months were recruited among 86 HD-patients. All patients underwent identical assessment immediately before and after the full HD-session. This consisted of full biological assessment, including malondialdehyde (MDA) and total antioxidant activity (TAOA); and brain BOLD-fMRI using the motor paradigm in block-design. RESULTS: Functional BOLD-fMRI maps of motor area M1 were obtained from the HD patient before and after the hemodialysis session, important decrease in the intensity of brain activation of the motor area after HD, and important increase of the size of the volume of brain activation were observed, these changes are reflecting brain plasticity that is well correlated to OS levels. Individual patients MDA and TAOA before and after the hemodialysis sessions demonstrated a clear and systematic increase of the OS after HD (P-value=0.03). Correlation of BOLD-fMRI maximal signal intensity and volume of activated cortical brain area behaviors to MDA and total TAOA were close to 1. CONCLUSION: OS is systematically increased in HD-patients after the HD-process. Indeed, the BOLD-fMRI shows a remarkable sensitivity to brain plasticity studied cortical areas. Our results confirm the superiority of the BOLD-fMRI quantities compared to the biological method used for assessing the OS while not being specific, and reflect the increase in OS generated by the HD. BOLD-fMRI is expected to be a suitable tool for evaluating the plasticity process evolution in hemodialysis brain patients.

Pulmonary Tuberculosis Sequelae: Spectrum of Radiologic Findings and Review of Literature

Pulmonary tuberculosis (TB) is a common worldwide infection and a medical and social problem causing high mortality and morbidity; especially in developing countries.In accordance with the virulence of the organism and the defenses of the host; tuberculosis can occur in the lungs and in extrapulmonary organs. A variety of sequelae and complications can occur in the pulmonary and extrapulmonary portions of the thorax in treated or untreated patients.In this article; we aimed to review the characteristic imaging findings of various sequelae of thoracic tuberculosis affecting the lung parenchyma; airways; vessels; mediastinum; pleura; and chest wall