Navigating the complexity of Guillain-Barré syndrome and Miller-Fisher syndrome overlap syndrome: a pediatric case report.

Guillain-Barré syndrome/Miller-Fisher syndrome (GBS/MFS) overlap syndrome is an extremely rare variant of Guillain-Barré syndrome (GBS) in which Miller-Fisher syndrome (MFS) coexists with other characteristics of GBS, such as limb weakness, paresthesia, and facial paralysis. We report the clinical case of a 12-year-old patient, with no pathological history, who acutely presents with ophthalmoplegia, areflexia, facial diplegia, and swallowing and phonation disorders, followed by progressive, descending, and symmetrical paresis affecting first the upper limbs and then the lower limbs. An albuminocytological dissociation was found in the cerebrospinal fluid study. Magnetic resonance imaging of the spinal cord showed enhancement and thickening of the cauda equina roots. The patient was treated with immunoglobulins with a favorable clinical outcome.

[Portal leiomyosarcoma: An extremely rare location!] / Léiomyosarcome portal : une localisation extrêmement rare !

Leiomyosarcomas of large vessels are rare. It is a malignant tumour and the vast majority of these tumours arose from the inferior vena cava. We report a rare case of portal vein leiomyosarcoma, in a 56-years-old female patient admitted for chronic abdominal pain with abdominal mass in the right hypochondrium all evolving in a context of deterioration in general condition. We performed an abdominopelvic CT scan and then a MRI with contrast agent which objectified a large tissue mass containing areas of necrosis at the level of the duodeno-pancreatic compartment communicating at a large angle with the portal trunk over its entire length from the hepatic hilum to the spleno-mesenteric confluence responsible for a portal cavernoma downstream. This is associated with multiple secondary nodular tissue hepatic lesions. We also noted a respect for the fatty border separating the mass of the duodenal tract and the head of the pancreas, and also the absence of dilation of the pancreatic ducts making a pancreatic origin unlikely. To eliminate a duodenal origin of the mass we performed an upper digestive endoscopy which came back without any abnormality. An ultrasound-guided trans parietal biopsy of a secondary hepatic lesion was done and the pathological result of which speaks of a secondary hepatic lesion of a leiomyosarcoma.

Immune thrombocytopenia and cerebral thrombophlebitis in a patient on eltrombopag: A rare complication.

Thrombopoietin receptor analogs (TPO-RAs) are indicated for splenectomized immune thrombocytopenia refractory to corticosteroids or immunoglobulins, intravenous, or as second-line therapy when splenectomy is contraindicated. Herein, we report a case of left transverse and superior sagittal sinus thrombophlebitis in a 49-year-old woman with chronic immune thrombocytopenia who received 10 days of eltrombopag treatment. Etiologic assessment ruled out acquired thrombophilia and antiphospholipid syndrome. Pharmacovigilance investigation confirmed causality between eltrombopag and the cerebral events, necessitating the definitive discontinuation of the drug. The patient was treated with anticoagulants and anticonvulsants. This evolution was marked by clinical recovery and significant radiological improvement of the thrombotic event. Cerebral venous thrombophlebitis within TPO-RA treatment remains rare, and without codified recommendations, a strict assessment of patients at risk of thrombotic events remains necessary prior to TPO-RA initiation.

[Agenesis of the coeliac trunk : A case report]. / Agénésie du tronc cœliaque : à propos d'un cas.

Vascular anatomical variants in general, and of the celiac trunk (TC) in particular, are rarely reported in the literature because they are generally asymptomatic and detected incidentally by imaging examinations performed for other causes. We report a case of agenesis of the celiac trunk, with separate birth of its three branches directly from the abdominal aorta, discovered fortuitously during a CT scan performed as part of the extension assessment of colon adenocarcinoma in a woman. initially asymptomatic.

Free floating aorto-iliac thrombosis: A rare complication of COVID-19 pneumonia.

Arterial thrombosis encountered during sars-cov2 infections is a rare complication with a poor prognosis compared to venous ones. They generally occur in severe and critical clinical forms of covid19 [1,2]. The physiopathology of arterial thrombosis, even if not completely understood highlights hypercoagulability and excessive inflammation as risk factors with a major role of the endothelial lesions in their occurrence. The presence of cardiovascular risk factors in patients infected with covid19 is also discussed as a predisposing factor for arterial thrombosis [2,3]. We report the case of a North African male patient hospitalized for acute respiratory distress syndrome (ARDS) secondary to covid19 pneumonia, complicated by the occurrence of multiple arterial thrombosis of the aorto-iliac axis with the rare finding of two free floating thrombus in the aorta and the right common iliac artery. Clinically, the patient had developed acute bilateral lower limb ischemia and multi-organ failure and the evolution was dramatic with rapid worsening of the patient...s health and eventually his death. Thromboembolic complications are frequent during covid19 infection but the aortic localization is very rare. Its diagnosis is difficult and it has a poor prognosis. Our objective through this case report is to increase knowledge about arterial thromboembolic events while discussing their link to the sars-cov2 viral infection.

Brain MR imaging in acute hyperammonemic: Case report.

Acute hyperammonemic encephalopathy is rare and generally is not widely known; only a few pediatric cases were found in the literature. These lesions' clinical presentation differs significantly so they can mimic other lesions. In this case report, we discuss a 5-year-old boy who presented with generalized seizures and was unconscious in an apyretic context, for which she had a cranial computed tomographic and magnetic resonance imaging, both objectified an acute hyperammonemic encephalopathy resulting from an enzyme deficiency. Magnetic resonance imaging revealed lesions throughout the cortex, with the perirolandic and occipital cortices spared. This distribution of cerebral signal abnormalities on magnetic resonance imaging with an abrupt and profound neurological disorder is secondary to hyperammonemic. The knowledge of the magnetic resonance imaging results of this entity is essential to accelerate the diagnosis, and treatment, also to prevent sequelae.

Periventricular nodular heterotopy of the gray matter: A case report.

Periventricular focal nodular heterotopia is a rare secondary cerebral distortion caused by the interruption of neuronal migration from the periventricular germinal zone to the cortex during the fetal period. Clinically, it may manifest as epilepsy resistant to pharmacological treatments or rarely as mental retardation. We report a case of a six years-old male child who was subject to the intensive care unit for the management of refractory epilepsy. The diagnosis was done by magnetic resonance imaging of the brain, which revealed a nodular periventricular heterotopia of the gray matter. After the management of the status of epilepticus, the child remained spastic, aphasic with no contact with his environment.

Radiation doses during computed tomography scan imaging in Hassan II Hospital, Agadir, Morocco.

Introduction: the aim of this study was to establish local Diagnostic Reference Levels (DRLs) for four adult Computed Tomography (CT) examinations in the radiology department, Hassan II hospital of Agadir. Methods: during this survey, we have examined the data of 200 patients at an average of 50 per localization. A General Electric 16 CT with automatic exposure control system was used to perform all CT examinations. Scanner acquisition parameters, number of series, contrast medium use, rotation time plus slice thickness, the displayed Computed Tomography Dose Index (CTDIvol), and the Dose Length Product (DLP) were among the data collected for each diagnostic exam chosen. To evaluate the DRL and effective dose, the conversion factor and formalism of the International Commission on Radiological Protection (ICRP) were utilized. Results: the average effective dose (Eeff), the displayed CT dose index (CTDIvol), dose length product (DLP) were (7.28±2.35) mSv, (10.80±3.80) mGy and (428.35±138.26) mGy.cm respectively at chest CT. For abdomen-pelvis CT scan, there were (12.48±5.58) mSv, (9.30±2.99) mGy and (805.43±359.98) mGy. Those at chest abdomen-pelvic CT scan were (11.72±3.98) mSv, (10.82±2.53) mGy and (755.97±251.52) mGy.cm respectively. For lumbar CT, there were (12.12±2.32) mSv, (26.46±5.24) mGy and (787.00±149.37) mGy.cm respectively. Conclusion: the findings of this study shows that our values are slightly higher than those of developed countries. This first-ever CT practice evaluation at Agadir's Hassan II Hospital reinforced the need for further radiology training for computed tomography practitioners on parameters influencing image quality, dose, and protocols improvement.

[Aneurysm of the inferior vena cava : A case report]. / Anévrisme de la veine cave inférieure : à propos d'un cas.

Venous aneurysms in general, and of the inferior vena cava in particular (IVC), are rarely reported in the literature because they are generally asymptomatic and detected incidentally following complications such as thrombosis and pulmonary embolism, an Inferior vena cava (IVC) aneurysm is detected by imaging examinations performed for other causes. We report a case of IVC aneurysm classified as type I according to Gradman and Steinberg discovered incidentally during a follow-up CT scan in an asymptomatic woman followed for endometrial adenocarcinoma treated 6 years ago.

When the aortoiliac bifucation is occluded:Leriche syndrome.

Intoduction: Leriche syndrome is a special type of obliterating arterial disease of the lower limbs which results in thrombotic occlusion of the aortoiliac junction. Case report: We report the case of a 65-year-old patient with known cardiovascular and nephrological pathological history, who presented with acute abdominal pain with intermittent claudication of the lower limbs and in whom clinical examination found abolition of the femoral pulses. Discussion: Doppler ultrasound of the abdominal aorta revealed aortic thrombosis in the lower of the renal segment extended to the iliac bifurcation with damping of upstream circulatory speeds. We supplemented with a CT angiography of the aorta and lower limbs which demonstrated extensive arterial thrombosis from the abdominal aorta to the bilateral external iliac arteries.

[Role of helical computed tomography in petrous bone trauma: about 12 cases at the University Hospital Ibn Rochd of Casablanca]. / Place du scanner hélicoïdal dans le traumatisme du rocher: à propos de 12 cas au Centre Hospitalier Universitaire Ibn Rochd de Casablanca.

Temporal bone injuries occur in 14-22% of skull fractures occurring due to head trauma. The purpose of this study is to understand the role of helical computed tomography in petrous bone trauma and to show the different types of fractures and the associated lesions. We conducted a retrospective study of 12 patients with petrous bone trauma (including 10 men and 2 women) over a period of 14 months. The average age of patients was 30, ranging from 18 to 42 years. High-resolution multi-slice computed tomography of petrous bone without contrast agent injection, with infra-millimeter slices thickness of 0.6mm every 0.3mm, allowed to detect the following fractures: 8 extralabyrinthine transverse fractures; 1 extralabyrinthine longitudinal fracture; 2 translabyrinthine fractures and 1 oblique fracture. The associated lesions were dominated by: 5 ossicular lesions; 4 cases of temporal bone involvement and 2 cases of geniculate ganglion involvement. High-resolution computed tomography can confirm the presence of a fracture, show the orientation of the fracture line and specify the different structures affected. It can be performed for emergency assessment or after a period of observation.

F-FDG18PET/CT incidental detection of tumor-to-tumor metastasis in patients investigated for squamous cell lung cancer.

Tumor-to-tumor metastasis (TTM) is a well-known entity, although this is still an extremely rare phenomenon. The lung cancers are considered the most frequent metastatic donors while kidney cancers are the most common recipient. The finding of TTM is often incidental during a biopsy of metastases or on surgical specimens but never suspected on radiological assessment of tumor extension. The finding of an unexpected region of Fluorodeoxyglucose (FDG) uptake can occur when performing whole body Positron Emission Tomography/computed tomography (PET/CT) scan and potentially raises the possibility of a second primary tumor. However, PET/CT scan incidental detection of tumor-to-tumor metastasis has never been reported in English literature. We report here a case of clear cell renal carcinoma, receptor of metastases originating from an oligometastatic squamous cell lung cancer detected on the PET/CT scan performed as part of the extension workup. Morphological and immunohistochemical analysis of a percutaneous biopsy of the renal mass were consistent with the diagnosis of a metastasis of lung cancer into renal cell carcinoma. This is the first case of oligometastatic lung cancer with the occurrence of TTM suspected in PET/CT scan. Although this is a rare setting, it should be considered in daily practice, as it could potentially modify the oncological management offered to the patients.

When Arteria lusoria meets Truncus bicaroticus: one of the rarest combinations of aortic arch anomalies.

The Arteria lusoria or aberrant right subclavian artery (ARSA) constitutes one of the rarest malformations of the aortic arch, it can be associated with other congenital anomalies of the heart and large vessels, in particular the bi-carotid trunk or common origin of the carotid arteries (COCA) which is the presence of a single branch from the aorta giving off both right and left common carotid arteries. We report the case of a patient followed for severe mitral stenosis, and hospitalized for an ischemic cerebral vascular accident, a chest CT scan was performed in front of her clinical and biological degradation, which allowed the fortuitous discovery of an Arteria lusoria (aberrant retro-esophagealartery) associated with a Truncus bicaroticus.

Diagnostic performance of chest CT findings of COVID-19 with RT-PCR negative.

COVID-19 presented with lung abnormalities on computed tomography (CT) scans in patient with false negative RT-PCR, which are helpful in diagnosis of this emerging global health emergency. It's a case report the young woman of 35-year-old patient with 2019-nCoV pneumonia confirmed with IgM-IgG serology underwent thin-section Chest CT. Our patient has the Chest CT with some lung abnormalities, the Ground-glass opacities, crazy paving pattern and smooth interlobular septal thickening. The clinical findings and with conspicuous ground grass opacity lesions in the peripheral and posterior lungs on CT are highly suspected of 2019-nCoV pneumonia.

[Acute venous mesenteric ischemia in a young COVID-19 positive subject: a case report]. / Ischémie mésentérique aiguë veineuse chez un jeune sujet COVID-19 positif: à propos d'un cas.

Acute mesenteric ischemia (AMI) is due to a sudden decrease or interruption of mesenteric blood flow resulting in inadequate blood supply to the gastrointestinal tract. This causes ischemic and inflammatory lesions often progressing to necrosis in the absence of appropriate treatment. Vascular insufficiency may arise as a result of embolism or arterial thrombosis or venous thrombosis. We here report a rare case of mesenteric venous ischemia caused by coronavirus disease 2019 (COVID-19) in a 33-year-old man in whom diagnosis was based on ultrasound and, in particular, on computed tomography (CT).

Spontaneously expelled IUD and missing fragments in the uterine cavity.

The mechanical complications of IUD are so rare. We report a case of 36-year-old women who was spontaneously expelled IUD with missing fragments of copper IUD within the endometrial cavity. She underwent pelvic ultrasonography and Pelvic X-ray. Two missing pieces of IUD was removed using a grasping forceps intrauterine under ultrasound. Despite the rarity of mechanical complications, it is important to know whether precautions can prevent or reduce the risks of IUD use for contraception.

Paratesticular liposarcoma: a case report.

Paratesticular liposarcomas (PLS) is a very uncommon pathology type of paratesticular sarcomas, with less 200 similar cases reported to date in the English literature. There are a few cases regarding giant paratesticular liposarcoma measuring over 10 cm. We present an unusual case with a giant well differentiated PLS of the left testis extended to the pelvic cavity. We report the case of a 55-year-old man who presented with large left groin mass. The patient underwent left orchiectomy following a cure of a scrotal hernia. Histological and immunohistochemical findings were suggestive of a well-differentiated liposarcoma of spermatic cord. The surgical margins were positive. Metastatic work-up, which included CT of the thorax, abdomen and pelvis, did not reveal any distant metastasis in thorax but there is a left pathological external iliac lymph nodes and a left lateroplevic lipomatous mass extended to the iliac fossa and left parietocolic gutter up to the umbilicus measuring 15x7x17 cm. Our patient refused treatment. A review of the literature revealed that there are fewer cases of giant well differentiated paratesticular liposarcoma extended to the pelvic cavity were reported. This study focuses on the clinical characteristics and treatment of this rare type of tumours.

[Intramedullary lipoma: about a case]. / Lipome intramédullaire: à propos d'une observation.

Intramedullary lipomas are rare benign lesions accounting for approximately 1% of bone marrow cancers. We report a new case of histologically confirmed non-dysraphic intramedullary lipoma. The study involved a 46-year old female patient who had undergone surgical biopsy for medullary lipoma 6 months before and who did not have radiological reports prior to this surgery. She suffered from rachialgias, sensory disorders, difficulties to walk and recently aggravated muscular weakness. Medullary MRI objectified well-defined mass presenting hypersignal on T1 and on T2 measuring 8cm x 2.5cm in the conus terminalis. Magnetic resonance imaging is the gold standard for the exploration of intramedullary lipomas. It allows early diagnosis as well as surgical management before the onset of irreversible neurological complications.

[Osteoid osteoma: about a case]. / L'ostéome ostéoïde: à propos d'un cas.

Osteoid osteoma is a benign primary bone tumor. This tumor is relatively frequent, accounting for 12% of all benign bone tumors and about 2-3% of all bone tumors. We report a new case of osteoid osteoma confirmed histologically. A 30-year old patient was referred for evaluation of chronic ankle pain. Front and lateral radiographs of the ankle showed a heterogeneous lesion located in the neck of the talus without soft tissue abnormalities. The CT scan of the ankle showed a nodular, hypodense lesion located in the neck of the talus with a limited osteosclerotic reaction.

[MRI relevance in femoral head osteonecrosis: 3 case studies]. / Interet de l'irm dans l'osteonecrose la tete femorale a propos de 3 cas.

INTRODUCTION: Aseptic osteonecrosis of the femoral head is the partial or total destruction of the femoral head due to impaired blood flow. It affects young adults (30-60 years), predominantly male (3 male:1 female) and is often bilateral. The aim of the present work is to define the role of MRI in the diagnosis, classification and therapeutic management of osteonecrosis of the femoral head. MATERIALS AND METHODS: This study focused on three observations of osteonecrosis of the femoral head in the 20 Aout Radiology Department of the Ibn Rochd of Casablanca University Hospital with a review of the literature. All patients underwent MRI of both hips with sagittal sequences, coronal T1, T2 and T2 SE DP Fat Sat. RESULTS: The ages of our patients were 62 years for case 1 (male); 37 years for case 2 (female) and 58 years for case 3 (male). The MRI in all 3 patients objectified: subchondral bone fragment on the outer compartment of the femoral head bilaterally with minimal bilateral effusion in the first patient. In the other two patients, we note the presence of subcortical signal abnormalities of the femoral heads with demarcation piping T1 hypointense, T2 hyperintense and associated subchondral fractures. A minimal effusion was also observed. CONCLUSION: Medical imaging is an essential element of the radiological diagnosis of osteonecrosis of the femoral head. MRI finds its best indication in the precocious and differential diagnosis, as well as the classification of osteonecrosis of the femoral head.

INTRODUCTION: L'ostéonécrose aseptique de la tête fémorale est la destruction partielle ou totale de la tête du fémur due à l'altération de la circulation sanguine. Elle touche l'adulte jeune (30­60 ans) avec prédominance masculine (3H/1F). L'atteinte est souvent bilatérale. Le but de ce travail est de définir la place de l'IRM dans le diagnostic, la classification et la prise en charge de l'ostéonécrose aseptique de la tête fémorale. MATERIEL ET METHODE: L'étude porte sur 3 observations d'ostéonécrose aseptique de la tête fémorale colligées au Service de Radiologie 20Aout du CHU Ibn Rochd de Casablanca avec revue de littérature. Tous les malades ont bénéficié d'une IRM des hanches avec séquences sagittale, coronale T1, T2 SE et T2 DP Fat Sat. RESULTATS: Les âges de nos patients étaient de 62 ans, 37 ans et 58 ans avec 2 hommes et une femme. L'IRM réalisé chez les 3 patients a objectivé un fragment osseux sous chondral au niveau du compartiment externe de la tête fémorale de façon bilatérale chez le premier patient et chez les deux autres patients, la présence des anomalies de signal sous corticales des têtes fémorales avec les liserés de démarcation en hyposignal T1 et hypersignalT2 associés à des fractures sous chondrales. L'épanchement articulaire minime a été observé chez tous les patients. CONCLUSION: L'imagerie médicale constitue l'élément essentiel du diagnostic radiologique d'ostéonécrose aseptique de la tête fémorale. L'IRM trouve sa meilleure indication dans le diagnostic positif, différentiel et la classification de l'ostéonécrose de la tête fémorale.