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Alaya W, Boubaker F, Mrabet H, Lassoued N, Ajili R, Jerbi S, Zehani A, Bouchahda H, Zantour B, Larbi F, Sfar MH. [Transient thickening of the pituitary stalk followed by a supra-pituitary Langerhansian histiocytosis : consequence or mere coincidence ?]. Rev Med Liege 2023; 78:189-192. [PMID: 37067833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
One of the difficult challenges in endocrinology is the etiological diagnosis of isolated thickened pituitary stalk (PS). We report the case of a woman in whom a thickened PS was diagnosed following the onset of central diabetes insipidus revealed by polyuria-polydypsia syndrome of late pregnancy and postpartum. The pituitary exploration showed panhypopituitarism with disconnecting hyperprolactinemia. An etiological investigation for an inflammatory, granulomatous or tumour cause was carried out, but was negative. Postpartum lymphocytic hypophysitis was then retained. However, the course was puzzling with a control pituitary MRI showing disappearance of the PS thickening with paradoxical appearance of a supra-pituitary tumour, the biopsy of which concluded of being a Langerhansian histiocytosis. This paradoxical sequence is unusual and has not been reported before. It called into question the autoimmune lymphocytic origin of the thickened PS, initially considered, and raised the likelihood of a causal relationship between this PS thickening and Langerhansian histiocytosis.
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Affiliation(s)
- Wafa Alaya
- Département d'Endocrinologie, Diabétologie et Médecine interne, CHU Tahar Sfar Mahdia, Tunisie
| | - Fadia Boubaker
- Département d'Endocrinologie, Diabétologie et Médecine interne, CHU Tahar Sfar Mahdia, Tunisie
| | - Houcem Mrabet
- Département d'Endocrinologie, Diabétologie et Médecine interne, CHU Tahar Sfar Mahdia, Tunisie
| | - Najoua Lassoued
- Département d'Endocrinologie, Diabétologie et Médecine interne, CHU Tahar Sfar Mahdia, Tunisie
| | - Rihab Ajili
- Département de Médecine Interne, Hôpital El Jem Mahdia, Tunisie
| | - Saida Jerbi
- Département de Radiologie, CHU Tahar Sfar Mahdia, Tunisie
| | - Alia Zehani
- Département d'Anatomopathologie, CHU La Rabta Tunis, Tunisie
| | - Haifa Bouchahda
- Département de Gynécologie-Obstétrique, CHU Tahar Sfar Mahdia, Tunisie
| | - Baha Zantour
- Département d'Endocrinologie, Diabétologie et Médecine interne, CHU Tahar Sfar Mahdia, Tunisie
| | - Fatma Larbi
- Département d'Endocrinologie, Diabétologie et Médecine interne, CHU Tahar Sfar Mahdia, Tunisie
| | - M-Habib Sfar
- Département d'Endocrinologie, Diabétologie et Médecine interne, CHU Tahar Sfar Mahdia, Tunisie
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Elloumi Y, Mrabet H, Boubaker F, Abderrahim Y, Zantour B, Lassoued N, Alaya W, Sfar H. Un diabète sucré associé à un situs inversus complet et une agénésie de corps et de la queue du pancréas : à propos d’un cas. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Abderrahim Y, Elloumi Y, Mrabet H, Boubaker F, Zantour B, Lassoued N, Alaya W, Sfar H. Le jeune de Ramadan est-il possible en cas d’insuffisance surrénalienne ? Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Amor BB, Sayadi H, Jemel M, Mrabet H, Hadhri R, Slim T, Klii R, Khochtali I. Erdheim-chester disease revealed by diabetes insipidus. Pan Afr Med J 2019; 33:293. [PMID: 31692902 PMCID: PMC6815502 DOI: 10.11604/pamj.2019.33.293.19194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/20/2019] [Indexed: 12/12/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a very rare and aggressive form of non-Langerhans histiocytosis with unclear pathogenesis. Because of the heterogeneity of clinical presentation, diagnosis is often challenging and delayed. Currently, Interferon alpha is the first line treatment that is associated with a better survival. The prognosis is relatively poor, especially in case of neurological and cardiovascular involvement. Herein, we report the case of a 64-year-old Tunisian female patient presenting an aggressive form of ECD revealed by diabetes insipidus and cerebellar ataxia with a diagnosis delay of 4 years. The assessment of disease extent had also shown associated asymptomatic cardiac and bone involvement. Pegylated Interferon alpha was started at high dose allowing disease stabilization. This case illustrates that physicians should be aware of the heterogeneous manifestations of ECD in order to insure an early diagnosis and treatment. Long-term and regular follow-up is crucial because of the risk of disease progression.
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Affiliation(s)
- Bilel Ben Amor
- Fattouma Bourguiba University Hospital, Department of Endocrinology, Monastir, Tunisia
| | - Hanene Sayadi
- Fattouma Bourguiba University Hospital, Department of Endocrinology, Monastir, Tunisia
| | - Manel Jemel
- National Institute of Nutrition, Department of Endocrinology Tunis Tunisia
| | - Houcem Mrabet
- Fattouma Bourguiba University Hospital, Department of Endocrinology, Monastir, Tunisia
| | - Rym Hadhri
- Fattouma Bourguiba University Hospital, Department of Anatomopathology, Monastir, Tunisia
| | - Tensim Slim
- Fattouma Bourguiba University Hospital, Department of Endocrinology, Monastir, Tunisia
| | - Rym Klii
- Fattouma Bourguiba University Hospital, Department of Endocrinology, Monastir, Tunisia
| | - Ines Khochtali
- Fattouma Bourguiba University Hospital, Department of Endocrinology, Monastir, Tunisia
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Bouhajja H, Abdelhedi R, Amouri A, Hadj Kacem F, Marrakchi R, Safi W, Mrabet H, Chtourou L, Charfi N, Fourati M, Bensassi S, Jamoussi K, Abid M, Ayadi H, Mnif-Feki M, Bougacha-Elleuch N. Potential role of liver enzyme levels as predictive markers of glucose metabolism disorders in a Tunisian population. Can J Physiol Pharmacol 2018. [PMID: 29527933 DOI: 10.1139/cjpp-2017-0579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The relationship between liver enzymes and T2D risk is inconclusive. We aimed to evaluate the association between liver markers and risk of carbohydrate metabolism disorders, as well as their discriminatory power, for T2D prediction. This cross-sectional study enrolled 216 participants classified as normoglycemic, prediabetic, newly diagnosed diabetics, and diagnosed diabetics. All participants underwent anthropometric and biochemical measurements. The relationship between hepatic enzymes and glucose metabolism markers was evaluated by analyses of covariance. The associations between liver enzymes and incident carbohydrate metabolism disorders were analyzed through logistic regression and their discriminatory capacity to predict T2D by ROC analysis. High AP, ALT, γGT, and AST levels were independently related to decreased insulin sensitivity. Interestingly, a higher AP level was significantly associated with an increased risk of prediabetes (p = 0.017), newly diagnosed diabetes (p = 0.004), and T2D (p = 0.007). An elevated γGT level was an independent risk factor for T2D (p = 0.032) and undiagnosed T2D (p = 0.010) in prediabetic and normoglycemic subjects, respectively. In ROC analysis, AP was a powerful predictor of incident diabetes and significantly improved T2D prediction. Liver enzymes within the normal range, specifically AP levels, are associated with increased risk of carbohydrate metabolism disorders and significantly improved T2D prediction.
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Affiliation(s)
- Houda Bouhajja
- a Unit of Obesity and Metabolic Syndrome, Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Rania Abdelhedi
- b Laboratory of Molecular and Cellular Screening Processes, Center of Biotechnology of Sfax, Sfax, Tunisia
| | - Ali Amouri
- c Department of Gastroenterology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Faten Hadj Kacem
- a Unit of Obesity and Metabolic Syndrome, Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Rim Marrakchi
- d Biochemistry Laboratory, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Wajdi Safi
- a Unit of Obesity and Metabolic Syndrome, Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Houcem Mrabet
- a Unit of Obesity and Metabolic Syndrome, Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Lassaad Chtourou
- c Department of Gastroenterology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Nadia Charfi
- a Unit of Obesity and Metabolic Syndrome, Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mouna Fourati
- a Unit of Obesity and Metabolic Syndrome, Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Salwa Bensassi
- a Unit of Obesity and Metabolic Syndrome, Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Kamel Jamoussi
- d Biochemistry Laboratory, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mohamed Abid
- a Unit of Obesity and Metabolic Syndrome, Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Hammadi Ayadi
- b Laboratory of Molecular and Cellular Screening Processes, Center of Biotechnology of Sfax, Sfax, Tunisia
| | - Mouna Mnif-Feki
- a Unit of Obesity and Metabolic Syndrome, Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Noura Bougacha-Elleuch
- e Laboratory of Molecular and Functional Genetics, Faculty of Sciences of Sfax, University of Sfax, Tunisia
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Mrabet H, Manai R, Hattab N, Mrabet A, Kefi M, Ouni J, Talbi M. L’épilepsie dans le secteur privé : l’exemple de l’unité de préparation à la chirurgie de l’épilepsie de la clinique Soukra, Tunisie. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mrabet H, Batti H, Attia N, Mrabet A. PO31-FR-20 Could electroencephalography be suitable and reliable for dementia diagnosis? J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)71238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mrabet H, Belhedi N, Bouchlaka S, El Gaaied A, Mrabet A. GEFS+ is not related to the most common mutations of SCN1B, SCN1A and GABRG2 in two Tunisian families. Neurol Sci 2008; 28:311-4. [PMID: 18175077 DOI: 10.1007/s10072-007-0844-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 09/28/2007] [Indexed: 11/28/2022]
Affiliation(s)
- H Mrabet
- Neurological Department, Charles Nicolle Hospital, Tunis, Tunisia
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Abstract
INTRODUCTION Hypothyroidism is frequently associated with different neuromuscular disorders. However myotonia is rarely a revealing feature. CLINICAL CASES Two patients aged 28 and 31 years consulted for a progressive myotonia. Blood and thyroid analysis revealed peripheral hypothyroidism with low FT4 and high TSH levels. Outcome was favorable with thyroid hormone substitution. Myotonia regressed and thyroid hormone levels returned to normal. CONCLUSION Myotonia may reveal hypothyroidism. The pathogenic mechanism of this myotonia is an unknown. Good outcome with thyroid hormone substitution requires a systematic thyroid hormone screening in patients presenting neuromuscular manifestations.
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Affiliation(s)
- H Mrabet
- Service de Neurologie, EPS Charles Nicolle, Boulevard 9 Avril, 1006 Tunis, Tunisia
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Mrabet A, Mrabet H, Ben Ali N, Batti H. F - 24 Les formes bénignes de sclérose en plaques : à propos d’une série hospitalière. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mrabet H, Cherif A, Batti H, Belaaj T, Mrabet A. N - 20 Les performances mnésiques d’enfants avec épilepsie généralisée idiopathique. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mrabet H, Mrabet A, Mansour M. Epidemiological and medical aspects of epilepsy in the elderly. Tunis Med 2007; 85:67. [PMID: 17424714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- H Mrabet
- Service de Neurologie, EPS Charles Nicolle, Tunis
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Nagi S, Bouchriha M, Sebaï R, Marrakchi-Turki Z, Zouaoui W, Mrabet H, Megdiche H, Ben Slama C, Touibi S. [Imaging of cerebrotendinous xanthomatosis]. J Radiol 2006; 87:1883-6. [PMID: 17213773 DOI: 10.1016/s0221-0363(06)74169-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Cerebrotendinous xanthomatosis is a rare lipid storage disorder due tocaused by an autosomal recessive inherited defect of the hepatic mitochondrial sterol 27 hydroxylase. It's characterized by accumulation of cholestanol and cholesterol in many tissues, in particular tendons and brain, with tendon xanthomas, juvenile cataracts, and neurological abnormalities. MR imaging showed typical bilateral and symmetrical involvement of the dentate nuclei. Early and long- term treatment may improve neurologic function. The authors present a case of cerebrotendinous xanthomatosis and describe ultrasound, computed tomography, and magnetic resonance findings.
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Affiliation(s)
- S Nagi
- Service de Neuroradiologie, Institut National de Neurologie, Tunis, Tunisie.
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Mrabet H, Touibi S, El Bahri-Ben Mrad F, Megdiche H, Mrabet A. [Fibromuscular dysplasia of the carotid and vertebro-basilar arteries (in French)]. J Neuroradiol 2006; 33:70-1. [PMID: 16528210 DOI: 10.1016/s0150-9861(06)77232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mrabet H, Bahri Ben Mrad F, Touibi S, Mrabet A. [Presentation of a cavernous angioma with an oculomotor nuclear syndrome: a case report]. Rev Neurol (Paris) 2006; 162:238-9. [PMID: 16518266 DOI: 10.1016/s0035-3787(06)75006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The nuclear syndrome of the oculomotor nerve, first described in 1981, is characterized by ipsilateral third nerve palsy and elevation paresis of the contralateral eye. CASE REPORT A 59-year-old man suddenly developed diplopia and headache. Neurological examination showed nuclear ophthalmoplegia of the left third nerve without any other neurological abnormality. MRI findings demonstrated a typical, popcorn-like, smoothly circumscribed left posterior lesion. Surgical resection was not performed because of the deep localization. Spontaneous bleeding developed. CONCLUSION This neuro-ophthalmological complication of a cavernous angioma, as seen in our patient, has rarely been described in the literature. The clinical presentation and anatomic elements of the nuclear oculomotor syndrome are discussed. This exceptional localization provides a useful illustration of anatomoclinical correlations.
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Affiliation(s)
- H Mrabet
- Service de Neurologie, EPS Charles Nicolle, Tunis, Tunisie.
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Abstract
Dyke-Davidoff-Masson syndrome is a condition characterized by seizures, facial asymmetry, contralateral hemiplegia or hemiparesis and mental retardation. We report the clinical and imaging features in two patients with epilepsy revealing a Dyke-Davidoff-Masson syndrome. Brain MRI showed unilateral loss of cerebral volume with hypertrophy and hyperpneumatization of the paranasal sinuses and mastoid cells. Ipsilateral fronto-parietal polymicrogyria was present in one patient.
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Abstract
INTRODUCTION Balo's concentric sclerosis is a rare variant of multiple sclerosis described by Balo in 1928. It is characterized by alternating rings of demyelination and spared myelin. CASE REPORT We report a case of Balo's concentric sclerosis diagnosed by the typical MRI findings of concentric rings of demyelination. Medullar and brain localisation were found and clinical course was good under intravenous corticosteroids. CONCLUSION MRI provides the best diagnostic information for Balo's concentric sclerosis, allowing early diagnosis and treatment.
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Affiliation(s)
- S Nagi
- Service de Neuroradiologie, Institut National de Neurologie, La Rabta, Tunis, Tunisie
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Bahri D, Mrabet H, Ben Mrad F, Ksontini I, Fredj M, Mrabet A. [Neuromyositis revealing a systemic lupus erythematosus: a case report]. Rev Med Interne 2004; 25:533-4. [PMID: 15219375 DOI: 10.1016/j.revmed.2004.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Accepted: 03/29/2004] [Indexed: 10/26/2022]
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Fredj M, Mrabet H, Gouider R, Mrabet A. [Cerebral tuberculomas]. Rev Neurol (Paris) 2003; 159:795-8. [PMID: 13679725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
We report eight cases of brain tuberculoma. The clinical presentation was polymorphous: partial epilepsy (n=4), headache (n=3), hemiplegia (n=1), meningitis (n=1), cerebellar syndrome (n=1). Six patients also had pulmonary tuberculosis, one had tuberculosis of the genital organs, and one had HIV co-infection. The brain CT scan and MRI were highly contributive to diagnosis and follow-up. Despite good compliance with an anti-tuberculosis regimen for at least 14 months, the course was favorable in only six patients. Adjunction of corticosteroids led to radiological improvement. Assessment of cell immunity demonstrated a diminished immunomodulator ratio. Cerebral tuberculoma should be searched for in patients with unexplained neurological manifestations and several intracerebral lesions, particularly if pulmonary or visceral tuberculosis and/or immunodepression is part of the clinical picture.
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Affiliation(s)
- M Fredj
- Service de Neurologie, EPS Charles Nicolle, Tunis, Tunisie
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