Clinical, Radiological, and Etiological Aspects of Pachymeningitis: A Study of 24 Cases.

Introduction and importance Hypertrophic pachymeningitis (HP) is an uncommon disorder with varied etiological origins and heterogeneous clinical presentation. Establishing the etiological diagnosis poses a challenge, but prompt identification provides a treatment window, potentially leading to a reversal of symptoms. MRI is the reference examination, allowing not only the early diagnosis of pachymeningitis but also the assessment of its extent and importance, detection of possible complications, and suggestion of etiology. Case presentation We conducted a retrospective study involving 24 patients recruited over 5 years for who brain imaging had revealed the presence of pachymeningitis. The average age of the patients was 40 years, with a male-to-female ratio of 0.6. Clinical discussion Headache was present in 54.17% of patients. All the patients underwent MRI examinations utilizing different sequences, with subsequent Gadolinium injection showing localized and asymmetrical meningeal thickening in 13 cases, and diffuse in the rest. The cerebrospinal fluid study unveiled an inflammatory fluid characterized by a lymphocytic predominance and hyperproteinorrhea, noted in 50% of the patients. The histopathological analysis of a stereotactic biopsy conducted on an individual patient revealed non-diagnostic results. The etiological investigation was dominated by tuberculosis, which was detected in 33.3% of cases. Idiopathic origin was identified in 16.7% of patients. Conclusion Meningeal thickening is rare, and the multitude of potential causes makes the etiological investigation challenging unless they fall within the scope of secondary meningeal disorders; otherwise, a dural biopsy becomes necessary, and the prompt initiation of treatment, along with determining the etiology influences the prognosis.

Acute Encephalitis During a SARS-CoV-2 Infection: A Case Report.

It was in December 2019 that the coronavirus causing COVID-19 was first detected in Wuhan, China. Although the primary clinical presentation is respiratory disease, an increasing number of reports worldwide have noted various neurological manifestations, such as acute encephalitis. We present a case of a 49-year-old female admitted with afebrile impaired consciousness, diagnosed with acute encephalitis and a severe infection of COVID-19. Clinical and radiological improvement was observed following treatment with corticosteroids.

Bilateral Chorea-Ballism Associated With Non-ketotic Hyperglycemia: A Case Report.

The intricate workings of uncontrolled diabetes and its effects on the nervous system are not fully understood. However, it is known that this condition can lead to various neurological manifestations, including altered consciousness and epileptic seizures. In this case study, a 66-year-old woman presented with abnormal ballistic movements and chorea due to severe hyperglycemia. The results of her brain MRI suggested diabetic striatopathy. Fortunately, her symptoms improved significantly with the normalization of blood glucose levels and appropriate medical intervention. While the exact pathophysiology remains elusive, there is speculation that dysfunction of dopaminergic activity may play a role. The management of these complications involves stabilizing blood glucose levels and providing symptomatic relief. Despite the limited understanding of the underlying mechanisms, these neurological complications generally have a positive prognosis.

Comprehensive Evaluation of Sporadic Late-Onset Cerebellar Ataxias: Clinical Presentation, Diagnostic Challenges, and Treatment Outcomes.

Sporadic late-onset cerebellar ataxias (SLOCA) present a diagnostic challenge due to their heterogeneous etiologies and complex clinical manifestations. This retrospective study aimed to conduct a comprehensive evaluation of six male patients diagnosed with SLOCA, with a mean age of 55 years and an average symptom onset at 47 years. All patients presented with gait and balance disturbances, with additional sensory abnormalities observed in two cases. Neurological examinations revealed varied cerebellar syndromes, including static and static-kinetic presentations, accompanied by peripheral neurogenic syndromes in some instances. Brain MRI findings showed cerebellar atrophy, predominantly involving the vermis, in a subset of patients. Biochemical and serological investigations yielded mostly unremarkable results, although two patients exhibited significant vitamin E deficiency and anti-Hu antibodies (anti-neuronal nuclear antibody type 1). Electromyography confirmed sensory axonal neuropathy in those with peripheral neurogenic syndromes. Treatment with TOCO 500 mg (Vitamin E) was administered to four patients, with follow-up indicating stable disease progression in two cases. This study underscores the complexity of SLOCA and the need for a multidisciplinary approach to diagnosis and management. Further research is warranted to elucidate the underlying mechanisms and improve clinical outcomes for affected individuals.

Cooccurrence of Myasthenia Gravis and Epilepsy: A Case Report.

Myasthenia gravis (MG) is an autoimmune disease characterized by weakness and rapid fatigue of the voluntary muscles. Epilepsy is a neurological disorder marked by recurrent, unprovoked seizures. We present a case of a 34-year-old woman with idiopathic generalized epilepsy who developed MG at 33. While the relationship between MG and epilepsy remains unclear, it is known that antiepileptic drugs can exacerbate MG. The rarity of this association suggests a need for cautious selection of antiepileptic treatments to avoid worsening either condition.

Opsoclonus-Myoclonus With Anti-YO Antibodies Revealing Breast Cancer: A Case Report.

Opsoclonus myoclonus syndrome (OMS) is a rare neurological disorder characterized by irregular, continuous, and chaotic eye saccades accompanied by myoclonus, defined by brief, shock-like muscle spasms in the arms or legs. This syndrome often presents with additional features such as cerebellar syndrome, nycthemeral rhythm disorders, hallucinosis, and irritability-type behavioral disorders. In adults, OMS is predominantly paraneoplastic, necessitating screening for onconeural antibodies (ONA). While specific medications for OMS are lacking, addressing the underlying cause may ameliorate its clinical manifestations. The presence of opsoclonus-myoclonus should prompt urgent and thorough investigation for an underlying cancer, given its frequent association with paraneoplastic neurological syndrome (PNS). Here, we present the case of a 39-year-old patient with opsoclonus associated with cerebellar ataxia, revealing a breast neoplasm with positive anti-YO antibodies. Through the review of the literature, we discuss the epidemiological, clinical, diagnostic, and therapeutic aspects of this rare situation.

Multiple cranial nerve palsies revealing blast crisis in patient with chronic myeloid leukemia in the accelerated phase under nilotinib during severe infection with SARS-COV-19 virus: Case report and review of literature.

Since the introduction of tyrosine kinase inhibitors as primary therapy for patients with chronic myeloid leukemia (CML), the prognosis of these patients has improved significantly, and the number of patients who progress to the blast phase has decreased considerably. We report the case of a 35 year-old CML patient in accelerated phase treated with nilotinib, who presents a severe COVID-19 infection requiring non-invasive ventilation, and who subsequently presents a multiple cranial nerve palsy revealing a blast crisis of his CML. Multiple cranial nerve palsy is a sign of neurological involvement of CML in its blast phase. The blast crisis represents a real challenge for the clinician, especially during COVID-19 infection. The treatment remains the association of a tyrosine kinase inhibitors with a chemotherapy protocol, as well as the administration of methotrexate and cytarabine by intrathecal and intravenous infusion in high doses. Despite the importance of the association of CML with COVID-19 infection, there is not yet enough data to know the true impact of this infection on the evolution of this hemopathy.

Acute Blindness as a Complication of Severe Acute Respiratory Syndrome Coronavirus-2.

Several neurological manifestations can occur in the acute phase or in post-infection severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In certain cases, they can even reveal the disease. Although some may be consequences of direct cellular viral invasion, many represent post-infectious inflammation mediated by autoimmune mechanisms. We report the case of a 60-year-old woman who was initially consulted for acute blindness without optic neuritis. Brain MRI revealed nonspecific demyelinating lesions without any radiological signs of optic neuritis. The patient underwent an exhaustive assessment and then the diagnosis of optic neuritis with a normal orbital MRI following a SARS-CoV-2 infection was reached.

Analysis of Fourteen New Cases of Meningovascular Syphilis: Renewed Interest in an Old Problem.

Neurosyphilis (NS) remains a public health problem. Several recent reports suggest a worldwide increase in the incidence of this condition. Various syndromes can occur in NS, such as syphilitic meningitis, meningovascular syphilis, parenchymatous and gummatous neurosyphilis. Syphilis meningovascular will be the focus of this study. We report 14 new observations of meningovascular syphilis. A review of demographic and clinical features, neuroimaging findings, cerebrospinal fluid changes, treatment and outcome, pathophysiology mechanism of meningovascular syphilis are presented.

Epilepsy in Morocco: Realities, pitfalls and prospects.

The World Health Organization (WHO) estimates that about 50 million people of all ages have epilepsy and nearly 85% of whom live in low- and middle-income (LMICs) countries. In Morocco, epilepsy is one of the major neurological health conditions, with an estimated prevalence of 1.1%. The management of patients is difficult due to multiple factors. The lack of neurologists whose number is currently 180, the uneven distribution of neurologists who are concentrated in large cities, 43% of whom are in Rabat and Casablanca alone; the low involvement of general practitioners in the management of epilepsy; the frequent consultation of traditional healers; and the low coverage of social security all contribute to the treatment gap. The management of epilepsy has advanced considerably since the early nineties. Several factors contributed to this progress: the increasing number of neurologists compared to previous years, the creation of well-equipped new academic centers, and small units of general neurology, in addition to the disuse of several antiepileptic drugs. However, much work remains to be done against the use of many forms of traditional practices and the low involvement of general practitioners in the management of epilepsy. This is the first study on epilepsy conducted in Morocco.

[Wernicke's encephalopathy: a rare complication of hyperemesis gravidarum]. / Encéphalopathie de Wernicke: complication rare de l'hyperemesis gravidarum.

Wernicke's encephalopathy is a deficiency disease resulting from severe thiamine deficiency (vitamin B1). It mainly occurs in alcoholic subjects, but sometimes it is difficult to diagnose. The absence of treatment leads to severe cognitive sequelae. Magnetic resonance imaging is the gold standard imaging modality to confirm the diagnosis. The diagnostic sign is T2-weighted hyperintensity in the periaqueducal, thalami and mammillary bodies. We report the case of a 30-year-old woman with abundant vomiting during the first trimester of pregnancy (hyperemesis gravidarum), causing symptomatic Wernicke's encephalopathy.

Neurosyphilis revealed by compressive cervical spine syphilitic gumma: a case report.

INTRODUCTION: Neurosyphilis is a sexually transmitted disease secondary to the invasion of the central nervous system by the Treponema pallidum. The spinal syphilitic gumma is rare. CASE PRESENTATION: We report a case of extradural cervical spinal syphilitic gumma revealed by spinal cord compression in a 58-year-old male. The epidural lesion was removed via a posterior approach. Histological examination revealed syphilis. Syphilis serologies were positive. Brain MRI showed an associated cerebro-meningeal syphilitic gumma. Antibiotic regime based on aqueous penicillin G was introduced for 14 days. DISCUSSION: Currently, there is an increase in the frequency of syphilis and changes in its clinical manifestations. Neurosyphilis can take atypical forms. Spinal syphilitic gumma is a rare manifestation and its association with cerebral involvement is exceptional. Diagnosis is based on serologies in the blood and cerebrospinal fluid. The place of imagery, especially magnetic resonance imaging, is essential. Neurosyphilis should be discussed as a possible differential diagnosis in evaluation of spinal and cerebral lesions.

Parkinsonism and chronic manganese exposure: Pilot study with clinical, environmental and experimental evidence.

Parkinsonism related to chronic Manganese exposure is notably due to focal lesions of the basal ganglia. Our study focused on epidemiological, clinical, toxicological and experimental aspects of Manganese-induced Parkinsonism in south of Morocco. It is a prospective study concerning the workers and the residents bordering on the 2 mines in the south of Morocco. The results of the study concerned 120 cases divided into 4 groups of patients: G1: 30 cases exposed to different incriminated toxic products, which present Parkinsonian signs, G2: 30 cases healthy and exposed, G3: 30 cases affected with Idiopathic Parkinson's disease, and G4: 30 cases healthy and unexposed (controls). The results from the first mine show that 5.7% of the sample developed Manganese-Induced Parkinsonism and this percentage is slightly higher (4.5%) than the second mine site. Chemical and biological analysis revealed high levels of Manganese. The majority of patients did not improve the clinical signs under L-dopa treatment. The authors underline the gravity of Manganese-induced Parkinsonism and propose a listing of the various exposures as well as a cartography of the regions of risk in Morocco.