[Cerebral neurosarcoidosis]. / Neurosarcoïdose cérébrale.

We report the case of a 37-year old patient with right optic neuropathy. Magnetic resonance imaging (MRI) showed T2 hypersignal in the midline, enhanced after gadolinium injection (figure 1). Cerebrospinal fluid (CSF) analysis revealed lymphocytic meningitis with 64 white blood cells associated with hyperproteinorachy. Chest CT scan suggested the diagnosis of granulomatous inflammation, namely Stage 2 sarcoidosis. The level of serum angiotensin-converting enzyme (ACE) was high. The patient underwent corticosteroid therapy with good outcome. Sarcoidosis is a granulomatous diffuse, multisystemic disorder of unknown etiology. Neurologic sarcoidosis occurs in 5-15% of cases and neurologic symptoms suggest it in 10-30% of cases. Meningoencephalitis and cranial nerve involvement are the most common cliniconeurological manifestations, that are very varied. Facial nerve is the most common nerve to be affected, followed by the optic nerve. Brain MRI can better identify brain lesions, manifesting as infiltrating nodules in T1-weighted hyposignal and in T2-weighted hypersignal enhanced after contrast injection. It mainly affects the suprasellar region with involvement of the hypothalamus, the pituitary peduncle and the optic chiasm. Other anomalies are easily identified by gadolinium contrast agent, including diffuse or nodular thickening of the leptomeninges manifesting as pachymeningitis and lesions in the brain parenchyma (parietal, frontal, cerebellar regions) or in the spinal cord. The diagnosis is based on combination of clinical, radiological, laboratory tests and on histological data. Treatment is based on corticotherapy as first-line therapy sometimes associated with immunosuppressants.

An unusual presentation of neurosarcoidosis with progressive hearing loss.

Sarcoidosis is a granulomatous disease of unknown etiology that can involve several organ system. Neurological manifestations are not common and mostly include cranial neuropathies. However, auricular disorders are rare and exceptionally inaugural. We describe the case of a 46-year-old lady presented with hearing loss as the initial manifestation of sarcoidosis, and aim to raise awareness of this condition, that is often associated with significant morbidity.

[Multiple meningeal and cerebral involvement revealing multifocal tuberculosis in an immunocompetent patient]. / Atteinte cérébro-méningée multiple révélant une Tuberculose multifocale chez un immunocompétent.

Tuberculosis is a public health problem in Morocco. Central nervous system involvement is nevertheless rare, occurring in the context of multifocal or miliary tuberculosis. However, it may be a mode of revelation even in an immunocompetent subject. We report the case of a 30-year old man with language disorder accompanied by significant impairment of general condition. Clinical examination showed Broca's motor aphasia, right-sided pyramidal syndrome and latero-cervical adenopathies. HIV serologic test was negative. Brain MRI showed lesions associating multiple intracranial tuberculomas and meningoencephalitis. Thoracic CT scan showed multiple pulmonary micronodules, cavity wall thickening and bronchiectasia of the right fowler and culmen. Lymph node biopsy revealed typical architecture of a TB granuloma. The diagnosis of multifocal tuberculosis was retained and the patient received anti-bacillary therapy associated with corticosteroid therapy with good clinico-radiological evolution. This study is peculiar due to the appearance and the seat of tuberculous lesions on brain imaging, the absence of immunodeficiency, a good evolution under treatment. It highlights the role of active and exhaustive assessment of associated extracerebral tuberculous infection in the case of cerebromeningeal lesion suggestive of tuberculosis.

Spinal cord ischemia secondary to transcatheter arterial chemoembolization for hepatocellular carcinoma.

Transcatheter arterial chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with unresectable hepatocellular carcinoma. Although considered relatively safe, TACE has been associated with several complications. Spinal cord ischemia secondary to TACE is an extremely rare but disastrous complication. We report a very rare case of spinal cord injuries after TACE, together with a literature review. During the procedure, the patient suddenly experienced sensory impairment below the T10 dermatome and bilateral lower extremity motor weakness. She was given high-dose steroids and supportive therapy. The sensory deficits nearly improved completely, but motor strength remained unchanged. Thereafter, a chest computed tomography scan showed tumor metastasis to the lungs. The patient is now receiving sorafenib and follow-up.