Subarachnoid hemorrhage in neurofibromatosis type 1: case report of extracranial cerebral aneurysm rupture into a meningocele.

Described here is a case of subarachnoid hemorrhage due to rupture of an extracranial vertebral artery (V3 segment) aneurysm in a patient with neurofibromatosis type 1 (NF-1). The pathophysiology of this never-before reported complication of NF-1 is examined in the light of a focused literature review and with illustrations characteristic of this unique case, involving complex malformations of the spine and meningeal spaces, as well as of the vertebral artery wall itself. All these abnormalities are directly related to the underlying NF-1 disease.

[Pneumococcal infection among community-acquired pneumonia. A retrospective study of 230 hospitalized children]. / Pneumonies aiguës communautaires: place des pneumonies à pneumocoque. Enquête rétrospective dans un service de pédiatrie d'Ile-de-France.

OBJECTIVES: To find arguments in favour of pneumococcal origin in community-acquired pneumonia. POPULATION AND METHODS: A retrospective analysis of the files of 230 children hospitalized between January 1st 1999 and June 30th 2001 for community acquired pneumonia was performed. The files were classified into 3 subgroups: I (N=7), confirmed (positive blood culture); II (N=134), probable (biological arguments); III (N=89), possible pneumococcal infection. Age of the children was also taken into consideration. RESULTS: All children in the subgroup I had fever>39 degrees C at admission and at least 1 of the 3 criteria (WBC> or=20.10(9)/l, neutrophils > or =10.10(9)/l, C-reactive protein level> or =60 mg/l). Dyspnea was more frequently asthmatiform in the subgroup III. Chest X-ray was not contributive. Before admission, 39% of the children were given one or several antibiotics, and so some of patients belonging to the subgroups II and III could have been infected by pneumococcus without possibility to confirm that. CONCLUSION: Results of this analysis suggest that some criteria may be useful for selecting initial antibiotherapy even though systematic early specific antipneumococcal immunization should reduce the frequency of this infection.

[Bone marrow reconversion and magnetic resonance imaging: case report]. / Le phénomène de reconversion médullaire et son aspect en imagerie par résonance magnétique : à propos d'un cas.

INTRODUCTION: Bone marrow is divided into red marrow mainly constituted of hemopoietic cells and fatty yellow marrow. In some situations, yellow marrow may be converted into red marrow and this process is called marrow reconversion. Magnetic resonance imaging may be misleading with an invading bone marrow neoplastic process. EXEGESIS: We report a patient with non-Hodgkin's lymphoma with vertebral invasion. Clinical features at presentation were misleading with lower limbs migratory pain suggestive of inflammatory myositis. An MRI study of thigh muscles revealed femoral nodular lesions suggestive of bone marrow reconversion. CONCLUSION: Bone marrow reconversion is a physiologic and reversible process. Awareness of its radiographic features may help to avoid a diagnostic biopsy procedure.

[Zollinger-Ellison syndrome of ovarian origin. Apropos of a case with a review of the literature]. / Syndrome de Zollinger-Ellison d'origine ovarienne. A propos d'un cas avec revue de la littérature.

We report a case of Zollinger-Ellison syndrome due to secretory G and D cells in an ovarian mucinous cystadenoma. Surgical resection of the tumour led to disappearance of clinical symptomatology and laboratory signs. Four other cases were found in the literature. The prognosis of the Zollinger-Ellison syndrome, due to a secretory ovarian tumour, appears to be favourable after oophorectomy.

[Spontaneous intrahepatic hemorrhage: a severe complication of the Hellp syndrome. Value of early radiologic diagnosis. Apropos of a case]. / Hémorragie intrahépatique spontanée: une complication grave du Hellp syndrome. Intérêt d'un diagnostic radiologique précoce. A propos d'une observation.

One case of spontaneous hepatic hemorrhage during a severe pre-eclampsia and Hellp syndrome (hemolysis, elevated liver function tests, low platelet count) is reported. This serious complication can be detected by ultrasonography and C.T. The normal sonographic appearance of the liver must prompt a new sonographic examination as soon as possible. C.T. of the abdomen confirmes the diagnosis and delineates the lesions more precisely. It is suggested that with the availability of ultrasound and computed tomography to diagnose and stage the hepatic hemorrhage, they have a systematic indication during the Hellp syndrome.

[Disk hypodensity and disk herniation]. / Hypodensité discale et hernie discale.

The authors report the case of a patient with a herniated lumbar disk and bacterial meningitis. CT scan showed central disk hypodensity at the hernia level, whilst full cytological and bacteriological study of the disk following surgery revealed no evidence of spondylodiscitis. The problem was thus that of consequences of "degenerative" events related to the herniation. Central or peripheral disk hypodensity must in no case be considered as specific of discitis when there is a concomitant disk herniation.

[Protein-losing enteropathy caused by intestinal metastases of melanosarcoma]. / Entéropathie exsudative par métastases entériques d'un mélanosarcome.

We report about the case of one patient with diffuse small bowel metastases of melanosarcoma, which were revealed by signs of malabsorption 2 years after the exeresis of the initial skin tumor. Metastases of melanosarcoma in the digestive tract, especially the small bowel, have polymorphic and hardly suggestive clinical signs. We lay stress on the high percentage of small bowel metastases of melanosarcoma pointed out by the anatomicopathological literature and on the lack of systematic clinical and radiological search for such metastases in the assessment and follow-up of the primary melanosarcoma.

[Reliability of the combination of ultrasonography-cystography in the study of urinary infection in children. Prospective study on 90 cases]. / Fiabilité du "couple" échographie-cystographie dans l'exploration de l'infection urinaire de l'enfant. Etude prospective portant sur 90 cas.

The authors report a prospective study concerning 90 children with a urinary tract infection, investigated for the first time by radiological and ultrasonographic techniques. Amongst these 90 children, 50 (i.e. 55% of cases) had a normal retrograde cystography and ultrasonography. These children did not have any IVU and medical surveillance proved to be sufficient. Ten patients had a normal retrograde cystography and abnormal ultrasonography. Intravenous urography carried out in these 10 cases revealed in 8 instances an abnormality of the upper urinary tract. Finally 30 children had an abnormal retrograde cystography, with reflux in 29 cases, leading to intravenous urography which yielded a pathological result in only half of the cases studied. This series confirms the central role of retrograde cystography. When it is normal, intravenous urography may be legitimately substituted by ultrasonography.

[Klüver-Bucy syndrome in herpetic meningoencephalitis]. / Syndrome de Klüver-Bucy au décours d'une méningo-encéphalite herpétique.

BACKGROUND: Klüver-Bucy syndrome (KBS) is an infrequent condition that includes, in its complete form, often massive amnesia, psychic blindness (so-called visual agnosia), oral tendencies, hypermetamorphosis, changes in emotional behavior and increased sexual activity. Anatomic lesions in KBS involve the temporal lobe cortex bilaterally, and the amygdala as well as temporal white matter. CASE REPORT: A 17-year-old patient treated for herpetic meningoencephalitis developed neuropsychological signs leading to the diagnosis of Klüver-Bucy syndrome. DISCUSSION: KBS can occur in various clinical conditions but herpetic encephalitis is the most frequent cause. KBS may be transient or partially regressive, but severe amnesia that may progress to Korsakoff syndrome is often persistent after herpetic encephalitis. Neuroleptics or carbamazepine can be used for symptomatic treatment.