Isolated Facial Diplegia: A Rare Presentation of Guillain-Barré Syndrome.

Guillain-Barré syndrome is an autoimmune condition typically characterized by progressive areflexic ascending motor deficit and paresthesia. However, atypical presentations, such as isolated facial diplegia, are rare and diagnostically challenging. We describe a unique case of Guillain-Barré syndrome in a 46-year-old male patient, presenting as isolated bilateral facial paralysis without preceding medical history. Symptoms included tongue heaviness, loss of taste, dysarthria, and inability to close eyelids. A neurological examination confirmed bilateral facial paralysis. Laboratory tests and cerebrospinal fluid analyses were unremarkable, except for albumin-cytological dissociation. Electromyography revealed severe demyelinating damage to facial nerves. The patient responded well to intravenous immunoglobulin therapy. This case highlights the necessity of considering Guillain-Barré syndrome in patients with isolated facial diplegia. A thorough clinical evaluation, supported by laboratory and electromyographic findings, is crucial for accurate diagnosis and effective treatment. Early identification and intervention are key for optimal outcomes in these atypical presentations.

[Neuromeningeal tuberculosis: clinical, paraclinical, therapeutic and evolutionary profile of 21 patients]. / Tuberculose neuro-méningée: profil clinique, paraclinique, thérapeutique et évolutif de 21 cas.

The purpose of this study was to investigate the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of patients with neuromeningeal tuberculosis. We conducted a retrospective study of 21 patients with neuromeningeal tuberculosis hospitalized in the Neurological Department between January 2002 and December 2016. Women were slightly more represented than men (SR=0.9), the age group between 20 and 40 years (47.61%) was predominant. The mean time between symptom onset and diagnosis was 25 days. Inaugural symptoms mainly included common signs (100%). Neurological signs included headache (61.90%), vomiting (47.61%) and motor deficit (33.33%). Lumbar puncture and brain CT scan were performed in 100% of cases. All patients received antibiotic therapy and corticosteroids. Outcome was favorable in 61.90% of cases, fatal in 9.52% of cases and marked by the persistence of neurological sequelae in 28.57% of cases. Neuromeningeal tuberculosis is an extremely polymorphic disease in its clinical and radiological manifestation. Early diagnosis and management is mainly associated with a favorable outcome.

[Neurological disorders secondary to vitamin B12 deficiency: about 29 cases]. / Les troubles neurologiques secondaires à une carence en vitamine B12: analyse de 29 cas.

Neurological disorders secondary to vitamin B12 deficiency are polymorphic and diverse. There have been very few studies conducted in the Moroccan as well as in the African population. This study aims to describe the clinical, paraclinical, evolutionary features of neurological manifestations in patients with vitamin B12 deficiency within the Department of Neurology at the Moulay Ismail Military Hospital, Meknes over a period of 18 years (1999-2017). The study involved 06 women and 23 men, with an average age of 57 years. The mean time between symptom onset and diagnosis was 3 months. Neurological manifestation was indicative of vitamin B12 deficiency in 100% of cases. The average hemoglobin level was 10 g/dl, the mean corpuscular volume was 115 fl. Medullary megaloblastosis and atrophic gastritis were found in 95% and 90% of cases respectively. Regular electromyography (EMG), electroencephalography (EEG) and visual evoked potentials (VEP) showed subclinical peripheral and optic neuropathies. In 20 cases they were caused by Biermer's anemia. All the patients received parenteral Vitamin B12 with good outcome. These results demonstrate the importance of early diagnosis in patients with a potentially serious neuropsychiatric condition as well as of rapid substitution treatment which is the only therapeutic option to secure a good outcome.

[Tuberculous meningoencephalitis revealed by psychiatric disorders: about a case]. / Méningo-encéphalite tuberculeuse révélée par des troubles psychiatriques: à propos d'un cas.

Tuberculous meningoencephalitis is fairly frequent in endemic countries and it is the most severe form of tuberculosis. Therapeutic failure is common because of diagnostic delay. This delay is primarily due to a wide clinical polymorphism and, in particular, to misleading forms. We here report a rare clinical case of tuberculous meningitis in a patient in prodromal phase of psychosis.

[Rickettsiosis associated with cerebral infarction: a new case study]. / Association rickettsiose et infarctus cérébral: une nouvelle observation.

Mediterranean spotted fever (MSF) is a rickettsiosis of the spotted fever group caused by rickettsia conorii. This zoonosis is benign but it can be complicated by severe neurological impairment (hence its severity). We report the case of a 49-year old patient hospitalized in the Department of Dermatology for rickettsiosis, who suffered from right massive hemiplegia of brutal onset. Magnetic resonance angiography (MRA) of the brain showed deep left sylvian fissure ischemic stroke. The diagnosis of conorii-type rickettsiosis has been retained based on the aspect of skin lesions and on positive sierologic testing with the indirect immunofluorescence method. Evolution was favorable under anti-biotherapy (Doxycycline and fluoroquinolone). Cerebral infarction, exceptionally reported in the framework of neurological manifestations of rickettsioses, is a complication that shouldn't be underestimated especially when etiologic assessment (cardiovascular in particular) is negative.

[Acute myelitis and viral hepatitis: about a case]. / Myélite aigue et hépatite virale A: à propos d'un cas.

Hepatitis A virus can manifest with severe and unusual neurological attack. We report the case of a 59-year old man with balance disorder associated with lower limb paresthesias and sphincter disorders. Spinal MRI was in favor of acute myelitis. Etiologic assessment showed viral hepatitis A (HVA) -specific IgM virus as the sole abnormality. Despite high-dose corticosteroid therapy, only partial recovery was seen. A systematic etiologic search for infection caused by hepatitis A virus (HAV) should be performed in every patient with acute myelitis even in the absence of clinical or biological signs suggestive of hepatitis, especially in endemic countries where vaccine prophylaxis is lacking.

[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.