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Hajhouji F, Benyaich Z, Laghmari M, Ghannane H, Ait Benali S. Spontaneous spinal epidural hematoma in a toddler presenting with torticollis: case report and literature review. Childs Nerv Syst 2023; 39:1935-1939. [PMID: 36738321 DOI: 10.1007/s00381-023-05870-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare entity, especially in toddlers and infants. The nonspecificity of its presenting symptoms in children may be a source of delayed diagnosis. CASE DESCRIPTION We report the case of a 20-month-old young boy without medical history who presented with irreducible torticollis, worsened a few days later by severe tetraplegia and respiratory distress. Spinal magnetic resonance imaging (MRI) showed a posterior epidural hematoma, extending from C3 to T1 and compressing the spinal cord. An urgent decompressive surgery via an extensive laminectomy and evacuation of the clot was performed. The patient demonstrated a partial neurological recovery on follow-up. CONCLUSION SSEH is a rare and serious condition that may compromise the functional and vital prognosis of the patient, hence the importance of prompt diagnosis and urgent treatment.
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Affiliation(s)
- Farouk Hajhouji
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Zakariae Benyaich
- Department of Neurosurgery, CHU Souss Massa, Agadir, Morocco.
- Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Benyaich Z, Hajhoui F, Laghmari M, Ghannane H, Benali SA. Ruptured intraventricular tuberculous brain abscess mimicking cystic neoplasm: a case report. Pan Afr Med J 2021; 39:122. [PMID: 34527138 PMCID: PMC8418180 DOI: 10.11604/pamj.2021.39.122.29369] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Central nervous system (CNS) tuberculosis is a potentially life-threatening condition that may manifest in different forms and simulate other pathologies. It rarely involves the ventricles and the occurrence of primary intraventricular tuberculous brain abscess (TBA) has exceptionally been reported. As far as we know, ruptured intraventricular TBA has not been described before. An immunocompetent 56-years-old man was admitted for sub-acute intracranial hypertension with behaviour disorders. Cranial magnetic resonance imaging (MRI) showed a cystic lesion of the third ventricle containing fluid-fluid level with biventricular hydrocephalus and debris in the occipital horns. A ruptured cystic neoplasm was first considered. The patient underwent surgery via a right transcortical transventricular approach, combining both microscope and endoscope. The puncture of the lesion brought pus and the Ziehl-Neelson (ZN) staining demonstrated acid-fast bacilli. Intraventricular tuberculous abscess is an extremely rare condition that can take an unusual radiological appearance. This observation highlights the consideration of tuberculosis within the list of differential diagnosis of intraventricular cystic lesions in immunocompetent hosts.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Farouk Hajhoui
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Benyaich Z, Laghmari M, Ait Benali S. Arachnoiditis Ossificans of the Lumbar Spine: A Rare Cause of Progressive Cauda Equina Syndrome. World Neurosurg 2021; 148:116-117. [PMID: 33508490 DOI: 10.1016/j.wneu.2021.01.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Arachnoiditis ossificans of the spine is a rare entity defined as an ossification of the leptomeninges resulting in neurologic decline. We describe the case of a 42-year-old woman, without any obvious predisposing factor, who presented with a progressive cauda equina syndrome. The imaging findings on magnetic resonance imaging were confusing by showing an atypical intraspinal lesion extending from L1 to S1. The computed tomography scan was more specific by showing suggestive images of a huge arachnoiditis ossificans of the lumbar spine. The patient underwent a large lumbar laminectomy with an incomplete resection of the ossified arachnoid. The histologic study confirmed the bony nature of the lesion. This illustrative case highlights the importance of helical computed tomography scan with multiplanar reconstruction for the diagnosis of arachnoiditis ossificans.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Marrakech, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Marrakech, Morocco; Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Marrakech, Morocco; Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Bellihi Y, El Marrakchi M, Benyaich Z, Laghmari M, Ghannane H, Ait Ben Ali S. Hématome sous-dural aiguë lombaire après manipulation chez un chiropraticien : à propos d’un cas. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.06.118] [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: 11/16/2022]
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Benyaich Z, Grich I, Laghmari M, Ghanane H, Aitbenali S. Analyse des déficits neurologiques après chirurgie vigile des gliomes encéphaliques. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.04.036] [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: 10/23/2022]
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Benyaich Z, Hajhouji F, Laghmari M, Ghannane H, Aniba K, Lmejjati M, Ait Benali S. Awake Craniotomy with Functional Mapping for Glioma Resection in a Limited-Resource-Setting: Preliminary Experience from a Lower-Middle Income Country. World Neurosurg 2020; 139:200-207. [PMID: 32311556 DOI: 10.1016/j.wneu.2020.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Awake craniotomy with brain mapping aims to maximize resection of gliomas located within eloquent regions while minimizing the risk of postoperative deficits. This technique is common practice in the developed world but has yet to be implemented in most low- and middle-income countries (LMICs). We assessed the feasibility, safety, and efficiency of functional-based glioma resection using minimal facilities in a limited-resource institution. METHODS This is a retrospective review of patients harboring gliomas within eloquent regions who underwent awake craniotomy and tumor resection guided by cortico-subcortical mapping at a tertiary hospital of an LMIC. Patient characteristics, surgical results, and functional outcomes were studied. RESULTS Twenty consecutive patients with a mean age of 37 years were enrolled in the study. Seizure, present in 70% of patients, was the major presenting symptom. Eighteen patients had diffuse low-grade gliomas and 2 patients had high-grade gliomas. Intraoperative events were dominated by seizures, occurring in 5 patients (25%). The average extent of tumor removal was 89.5% and the rate of total and subtotal removal was 85%. New postoperative deficits were observed in 5 patients (25%), and permanent deficits were found in 1 patient (5%). The main hurdles encountered were the difficulties in investigating patients and human resource availability. CONCLUSIONS Awake craniotomy with brain mapping for functional-based resection of gliomas can be safely achieved in a limited-resource institution with good functional and oncologic results.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.
| | - Farouk Hajhouji
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mohamed Lmejjati
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Benyaich Z, Laghmari M, Lmejjati M, Aniba K, Ghannane H, Ait Benali S. Acute Lumbar Spinal Subdural Hematoma Inducing Paraplegia After Lumbar Spinal Manipulation: Case Report and Literature Review. World Neurosurg 2019; 128:182-185. [PMID: 31078801 DOI: 10.1016/j.wneu.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traumatic spinal subdural hematoma is an extremely rare occurrence that requires urgent investigation and most often prompt intervention. To our knowledge, this is the first reported case related to a spinal manipulative therapy. CASE DESCRIPTION This report describes a case of traumatic lumbar subdural hematoma after a spinal manipulative therapy without any predisposing factor. A 23-year-old man was admitted to the emergency department for partial cauda equina syndrome after a spinal manipulation performed by a physiotherapist. Magnetic resonance imaging showed an acute spinal subdural hematoma at L2-L3 level with cauda equina compression. The patient underwent an emergency L2 laminectomy with evacuation of the hematoma. He recovered completely his neurologic functions after 1 week. CONCLUSION Practitioners of spinal manipulations should be aware of spinal subdural hematoma as a possible complication. A rapid diagnosis with magnetic resonance imaging is mandatory, and emergency surgical decompression is usually the optimal treatment for spinal subdural hematomas with severe neurologic deficit.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Mohamed Lmejjati
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
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