Non-Hodgkin's lymphoma revealed by a cerebral vascular stroke: A case report

Hemorrhagic lesions in CNS lymphoma are extremely rare. We report the case of a 75-year-old patient admitted to the emergency room following a classic hemorrhagic stroke. The CT scan showed a hyperdense tumor-like process with perilesional edema, the diagnosis reinforced by (MRI). The patient underwent macroscopically total surgical excision and the anatomo pathological examination concluded a diffuse non-Hodgkin's B large cell lymphoma. The follow up was marked by a clear clinical improvement. Primary cerebral lymphomas can be polymorphic, so this diagnosis should always be kept in mind during stroke manifestations. This case illustrates the diagnostic difficulty of this rare and poor prognosis condition.

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Primary central nervous system (CNS) lymphoma is relatively rare, representing only 1%–2% of all primary CNS malignancies. Hemorrhagic lesions in CNS lymphoma are extremely rare.

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This paper presents a case of A 75-year-old man admitted to the emergency room following a classic hemorrhagic stroke The CT scan showed a hyperdense tumor-like process with perilesional lesional edema, the diagnosis reinforced by (MRI). The patient underwent macroscopically total surgical excision and the anatomopathological examination concluded a diffuse non-Hodgkin's B large cell lymphoma. The follow up was marked by a clear clinical improvement.

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The clinical expression of primary cerebral lymphomas can be polymorphic, so this diagnosis should always be kept in mind during stroke manifestations. This case illustrates the diagnostic difficulty of this rare and poor prognosis condition.

A cerebellopontine angle metastatis of a male breast cancer: Case report

Male breast cancer is rare, less than 1% of men's cancers. The tumors occurring in the cerebellopontine angle remain a rare entity. Features suggestive of metastasis are acute onset, rapid progression of symptoms. We report a case of a 72-year-old man had a mastectomy and an axillary lymph node dissection for a breast cancer 22 years prior to this report. The patient was admitted with deterioration of level of consciousness with intracranial hypertension syndrome. The magnetic resonance imaging showed a cystic lesion in the left cerebellar hemisphere and the prepontine cistern. We proceeded to a large tumor resection. On the follow up, the patient presented a delayed emergence. A CT scan showed a small hematoma at the surgical site and triventricular hydrocephalus for which the patient underwent a ventriculoperitoneal shunt. This is the first described cerebellopontine angle metastasis of a male breast cancer and the first described case of a metastatic triple hormone negative breast cancer to the brain.

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A 72 years old man had a mastectomy and an axillary lymph node dissection for a breast cancer 22 years prior to this report. He was brought to our emergency for intracranial hypertension syndrome with disorders of consciousness.

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The magnetic resonance imaging showed a cystic lesion in the left cerebellar hemisphere compressing the pons, the acoustic-facial nerve bundle, with a peripheral contrast enhancement.

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This is the first described cerebellopontine angle metastasis of a male breast cancer and the first described case of a metastatic triple hormone negative breast cancer to the brain.

Extra dural hematoma following a high voltage electrocution accident: A case report

Electrification accidents is a serious pathology due to the passage of an electric current through the body. The clinical manifestation is mainly represented by skin lesions with burners of different degrees however all the tissues of the body can be affected. The cerebral manifestation is a rare entity described in the literature. In this paper, we report the case of a patient with an electrocution accident manifested by an extradural hematoma who has not encountered a similar case described in the literature. We therefore present this case which poses a poorly understood pathophysiological problem.

The immune checkpoint VISTA exhibits high expression levels in human gliomas and associates with a poor prognosis

In human gliomas, anti-tumor T cell responses are inhibited through induction of local and systemic immunosuppression. Immune checkpoint blockade is proving to be a success in several types of cancers. However, many studies reported that the treatment of glioblastoma patients with anti-CTLA-4 or anti-PD-1 has no survival benefit compared to standard chemotherapy. This study aimed to investigate the expression and role of VISTA, a newly described immune checkpoint regulator, in human gliomas. mRNA expression was assessed in a total of 87 samples from glioma patients. 57 glioma tissues were taken at different grades. 20 peripheral blood mononuclear cells (PBMC) samples were taken before surgery and ten after surgery, all from the same set of patients. As for the control, ten specimens of PBMC were taken from healthy donors. Protein expression using immunohistochemistry was performed for 30 patients. The Cancer Genome Atlas (TCGA) data set, was also used to investigate VISTA expression through analysis of RNA-seq data of 667 glioma patients. In the Moroccan cohort, VISTA gene expression was significantly upregulated in glioma tissues related to PBMC of healthy donors. This high expression was specific to patient tissues since VISTA expression in PBMC was low when assessed either before or after surgery. Besides, VISTA exhibited higher expression levels in grade III/IV relative to grade I/II glioma patients. Interestingly, VISTA correlated positively with PD-1 expression. PD-1 also showed elevated expressions in higher glioma grades. The TCGA cohort corroborated these observations. Indeed, VISTA was also found to be strongly expressed in high grades. It was positively correlated with other critical immune checkpoints. Finally, increased VISTA transcript levels were associated with weak overall survival of glioma patients. Our study highlighted a correlation between high levels of VISTA expression and poor prognosis in glioma patients. VISTA might be involved in glioma progression and could be considered as a possible new therapeutic target, especially in advanced gliomas.

Cervical spine dislocation on ankylosing spondylitis: A case report

Treatment of cervical spine fracture in patients with ankylosing spondylitis is difficult. Biomechanical changes related to ossified ankylosing spondylitis spine make cervical spine fractures highly unstable. They cover the entire width of the spine inducing.

multidirectional instability and the risk of neurological injuries. Treatment is more difficult that in the nonossified spine. Different treatments have been proposed including anterior stabilization, posterior stabilization, or both. This paper present a case of an 55-year-old man followed for ankylosing spondylitis admitted for fracture dislocation of c5-c6 following a minimal trauma of which it was operated 4 times in order to obtain a satisfactory reduction and stabilization from which we drew the importance of the osteosynthesis by combined way.

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This paper presents a case of a 55-year-old man followed for ankylosing spondylitis admitted for fracture dislocation of c5-c6 following a minimal trauma of which it was operated 4 times.

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To obtain a satisfactory reduction and stabilization from which we drew the importance of the osteosynthesis by combined way.

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Orthopedic treatment alone is inadequate. Isolated anterior or posterior osteosynthesis is also insufficient. The rule should be the combination of both (360◦ fixation) when technically feasible.

Surgical site infections in neurosurgery

Background: Surgical site infections in neurosurgery are serious due to their proximity to the central nervous system and their management is a challenge. The aim of our work is to report surgical site infections (SSI) in patients who underwent brain or spinal surgery and to describe their characteristics. Materials and method: We conducted a retrospective study involving patients who underwent surgery in our facility's neurosurgical emergency department over 5 years from January 2015 to December 2019. The data were collected from medical hospital and follow-up records. Results: Fifty-eight cases of SSI were identified out of 2889 operations in total, for a frequency of 2%. The series consisted of 36 men (62.07%) and 22 women (37.93%). The average age was 43.9 years (19-72 years). 46 patients (79.31%) had undergone urgent surgery and 12 patients (20.69%) for delayed surgery. 40 patients (68.97%) had undergone cranial intervention and 18 patients (31.03%) underwent spinal surgery. The identified germ was Staphylococcus aureus in 13 cases (76.48%). Mortality was 13.8% (8 out of 58 cases). Conclusion: The majority of microorganisms that cause the infections contaminate the surgical site intraoperatively. Preventive measures can reduce the rate of surgical site infections.

Spinal extradural angiolipomas: A case report

Angiolipoma are benign tumors composed of mature adipocytes ad mixed with abnormal vascular elements. It reportedly accounts for 0.1–0.5% of all spinal axis tumors in adults and is extremely rare in children.

This article describes a case of spinal extradural angiolipoma in a 35-year-old man, who presented with paraplegia and sphincter disorders, the MRI showed extradural spinal lesions at the level of T7 to T10, that squeezed the spinal cord. We attained total resection without any further neurological complication.

The diagnosis of SEALs initially can be challenging radiologically since they may imitate other spinal lesions. The gold standard treatment modality should always be surgery, however in some cases, total resection can not be done.

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This paper presents a 35-year-old man complaining for 1 months a numbness and lowerlimbs heaviness. The neurological examination revealed paraplegia with a muscle power was 2/5. However, in lower limbs, the deep tendon reflexes were absent, walking was impossible also without any sensitive disorder.

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MRI revealed T7-T10 extradural spinal lesion. The tumor appeared as an hyperintense on T1 and T2-weighted images, and as heterogeneous on STIR. Total resection after dissecting the tissue around the tumor. The histopathological examination of the specimens obtained, showed that the lesion was made up of fatty tissue and angioma-like tissue.

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SAL is a rare benign tumor and considered as a specific clinico-pathological entity. MRI is considered to be the “gold standard” in diagnosing SAL and surgery appears to be the treatment of choice.

Cerebral hydatid cyst during pregnancy: A case report

This paper presents the case of an 18-year-old woman in the 31st week of pregnancy complaining for 8 months a several episodes of vomiting and headache the neurological examination revealed muscle power was 3/5 on left side. The cerebral MRI revealed an intracranial hydatid cyst. The cyst was surgically removed under general anesthesia and put it on albendazole, the diagnosis has been confirmed by the histopathological examination. The patient gave a healthy baby 1 month later without any incident. No primary focus was found in the lungs, liver, or other organs. Primary cerebral hydatid cyst during pregnancy can be successfully treated by surgical and medical intervention, vomiting in a pregnant woman should be investigated to rule out other differential diagnosis.

The Promising IgSF11 Immune Checkpoint Is Highly Expressed in Advanced Human Gliomas and Associates to Poor Prognosis

Glioma is the most prevalent primary brain tumor. Immune checkpoint blockade has made a great stride in mending patient’s clinical outcome for multiple types of cancers. However, PD-1, CTLA-4, or VEGF blockade exhibited only poor outcome in glioma patients. This study aimed to explore the expression and role of IgSF11, an emerging immune checkpoint and a ligand of VISTA, in human gliomas. IgSF11 mRNA expression was assessed in human glioma patients at different grades using 2 independent cohorts, a set of 52 Moroccan samples, including 20 glioma tissues, 22 PBMC samples taken before and 10 PBMC samples taken after surgery; and a series of 667 patients from TCGA. In parallel, immunohistochemistry was performed to evaluate IgSF11 protein staining. IgSF11 gene expression was significantly upregulated in high grade glioma tissues, compared to low grade. IgSF11 protein also showed a significant expression in low and high-grade gliomas. Interestingly, IgSF11 expression seemed to correlate positively with other critical immune checkpoints such as PD1, PDL-1, VISTA, and surprisingly negatively with CTLA-4. Although, T cell markers appeared higher in advanced gliomas, T cell-produced pro-inflammatory genes showed similar expression levels, highly likely because of the potent immunosuppressive microenvironment. Indeed, increased expression of IgSF11 in advanced human gliomas associated with a poor overall survival. Our data strongly suggest that IgSF11 is an immune checkpoint, which is upregulated in advanced human gliomas and contributes to the immunosuppressive state resulting in a poor clinical outcome in glioma patients. IgSF11 could be considered as a possible promising therapeutic target in advanced human gliomas.

A rare complication of ventriculoperitoneal shunt: Pleural effusion without intrathoracic ventriculoperitoneal shunt catheter

Background:

Symptomatic pleural effusion following ventriculoperitoneal shunt (VPS) insertion is very rare and poorly understood in the literature in contrary to other mechanical complications.

Case Description:

We report a case of 15 month-year-old girl who had VP shunt for congenital hydrocephalus. Twelve months after surgery, she was diagnosed with massive hydrothorax. Chest X-ray and thoracoabdominal CT scan confirmed the right pleurisy and showed the tip of the peritoneal catheter in the general peritoneal cavity. We made thoracic drainage of the transudative pleural effusion. When we released the chest tube, 24 h after, the girl showed a respiratory distress again and the effusion resumed at the X-ray control. Her symptoms abated after the realization of a ventriculoatrial shunt “VAS.” Repeat chest X-ray confirmed the resolution of the hydrothorax.

Conclusion:

Despite the not yet well-understood mechanism of this rare and important VPS complication, management is simple based on X-ray confirmation, thoracentesis with biological analysis, and catheter replacement, especially in atrium “VAS.”

[Osteoblastoma of the parietal bone of the cranial vault: about a case]

L´ostéoblastome est une tumeur osseuse primitive peu fréquente, sa localisation au niveau de la voûte du crâne est extrêmement rare. Nous rapportons un cas d´ostéoblastome de l´os pariétal droit chez une femme âgée de 46 ans ayant des antécédents de traumatisme crânien bénin. Elle a présenté de façon progressive une tuméfaction pariétale droite douloureuse non inflammatoire. Le scanner crânio-cérébral a montré une lésion osseuse hyperdense respectant la table interne de l´os pariétal droit. La patiente a bénéficié d´abord d´une biopsie puis d´une résection totale de la lésion osseuse avec une cranioplastie au ciment méthyl-méthacrylique. Les suites post-opératoires étaient simples. L´examen anatomo-pathologique a montré qu´il s´agissait d´un ostéoblastome sans signes de malignité. Nous discuterons, à travers notre premier cas d´ostéoblastome de la voûte du crâne et une revue de la littérature, sa présentation clinique, l´examen anatomo-pathologique, les aspects radiologiques, ainsi que la prise en charge de cette rare pathologie.

Epidural cavernous haemangioma during pregnancy: a case report and a literature review

Cavernous haemangiomas are benign vascular malformations that can locate in the central nervous system. The epidural spinal location remains unusual. Pregnancy is known to be a precipitating factor. The aim of this study is to review general aspects of these lesions and specific facts about their relationship to pregnancy. A 32-year-old full-term pregnant woman is managed during early labor for a progressive spinal cord compression syndrome. After delivery, exploration by a lumbar MRI found an epidural vascular dorsal mass. Surgical exploration and histopathological examination confirmed the diagnosis of epidural cavernous haemangioma. The patient achieved complete recovery after 1 month. Spinal cavernous haemangiomas are rare malformations. Specific mechanisms seems to be involved in their growth during pregnancy. Although clinical and radiological presentation are spectacular and misleading, the prognosis is generally good, and urgent surgical treatment during pregnancy is usually not indicated.

Bibliometric profil of medical publication at Faculty of Medicine of Casablanca (2008-2017)

AIM

To measure productivity in scientific publications of teachers of the Faculty of Medicine and Pharmacy of Casablanca (FMPC).

METHODS

This is a descriptive bibliometric study of the publications of the FMPC, indexed in the Medline and Scopus databases, between 2008 and 2017. Articles of physicians affiliated to the FMPC or its university hospital center were included in this study.

RESULTS

With 1041 articles, the average scientific productivity of the FMPC was 38 articles / 100 teachers-year. These articles were published in 244 journals of which 18% in Pan African Medical Journal and 67% in French. In 58% of the articles, the type was "case reports". Dermatology and Genetics were the most prolific medical disciplines with 122 and 76 articles respectively. In surgery, Oto-Rhino-Laryngology and Gynecology-Obstetrics ranked first, with respectively 75 and 60 articles. The impact factor of the journals that published the articles of the FMPC ranged from 0.05 to 26.56 and was less than two in 84% of the cases. National and international scientific collaboration was 2.6% and 6.4% respectively.

CONCLUSION

The publication at the FMPC was largely unproductive in English-language journals with a high impact factor. Training in scientific medical writing would be a priority for faculty development and institutional visibility of the FMPC.