RESUMO
Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients. Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded. Results: The mean age at disease onset was 42.31 ± 7.29 years [28-58] and the mean age at surgery was 54.66 ± 8.51 years [34-70]. The median disease duration was 11.95 ± 4.28 years [5-22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases). Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.
RESUMO
Incidence of vertebral compression fractures (VCFs) is increasing due to the increase in human life expectancy and prevalence of osteoporosis. Percutaneous vertebroplasty (PVP) has become a widely used alternative treatment for symptomatic VCFs refractory to medical therapy. It is a minimally invasive technique involving injection most frequently of polymethylmethacrylate (PMMA) directly into the vertebral body through the pedicles. Percutaneous vertebroplasty yields good results in terms of early vertebral stabilization and prompt pain relief. This study describes the experience of the Department of Neurosurgery at Ibn Sina University Hospital (Rabat, Morocco) and assesses short and long term clinical and radiological outcomes and complications of vertebroplasty in a retrospective assessment of 36 vertebral compression fractures in 35 patients (16 men and 19 women subjects) who had been treated with vertebroplasty from November 2006 to December 2014.
Assuntos
Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Adulto , Idoso , Feminino , Seguimentos , Fraturas por Compressão/diagnóstico por imagem , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos , Polimetil Metacrilato/administração & dosagem , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Adulto JovemAssuntos
Fístula Carótido-Cavernosa/etiologia , Traumatismos Craniocerebrais/complicações , Traumatismos Faciais/complicações , Adulto , Angiografia , Fístula Carótido-Cavernosa/diagnóstico , Fístula Carótido-Cavernosa/terapia , Embolização Terapêutica/métodos , Humanos , Masculino , Prognóstico , Índices de Gravidade do TraumaAssuntos
Edema Encefálico/etiologia , Traumatismos Craniocerebrais/fisiopatologia , Crânio/patologia , Adolescente , Adulto , Idoso , Edema Encefálico/epidemiologia , Edema Encefálico/cirurgia , Traumatismos Craniocerebrais/cirurgia , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Crânio/cirurgia , Fatores de Tempo , Adulto JovemAssuntos
Neoplasias Encefálicas/patologia , Neoplasias do Ventrículo Cerebral/patologia , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Neoplasias Encefálicas/diagnóstico , Hemorragia Cerebral/etiologia , Neoplasias do Ventrículo Cerebral/diagnóstico , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico , Humanos , Hipertensão Intracraniana/etiologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , PrognósticoRESUMO
Intracranial epidermoid cysts are one of the rare tumors of all intracranial tumors. They represent 0,2 to 1% of intracranial tumors and 7% of tumors in the cerebellopontine angle. The pineal region is exceptionally subject to such kind of tumor. Cushing was the first to report the pineal localization of the epidermoid cyst in 1928. Up to now, 85 cases of pineal epidermoid cyst were cited in the literature. We report a clinical case concerning a 45 years old man who presented an intracranial hypertension during 18 months. The clinical examination found a hemiparesis with a facial hypoesthesis. The MRI showed a process of the pineal region. The patient underwent a surgery with a large resection. The histological examination confirms the epidermoid cyst. Many approaches were described in the literature. The outcome is related to this localization.
Assuntos
Neoplasias Encefálicas/patologia , Cisto Epidérmico/patologia , Glândula Pineal/patologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirurgia , Cisto Epidérmico/diagnóstico , Cisto Epidérmico/cirurgia , Humanos , Hipestesia/etiologia , Hipertensão Intracraniana/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Glândula Pineal/cirurgiaAssuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Corticosteroides/uso terapêutico , Adulto , Anticonvulsivantes/uso terapêutico , Terapia Combinada , Feminino , Departamentos Hospitalares/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Neoplasias Infratentoriais/diagnóstico , Neoplasias Infratentoriais/radioterapia , Neoplasias Infratentoriais/cirurgia , Leiomioma , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/radioterapia , Meningioma/diagnóstico , Meningioma/radioterapia , Pessoa de Meia-Idade , Marrocos , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/radioterapia , Segunda Neoplasia Primária , Neuroimagem , Neurocirurgia , Procedimentos Neurocirúrgicos , Pré-Medicação , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias Supratentoriais/diagnóstico , Neoplasias Supratentoriais/radioterapia , Neoplasias Supratentoriais/cirurgia , Neoplasias UterinasAssuntos
Procedimentos Neurocirúrgicos/métodos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto , Idoso , Vértebras Cervicais , Feminino , Humanos , Laminectomia/métodos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Resultado do TratamentoRESUMO
INTRODUCTION: Cerebellar glioblastoma is an uncommon adult lesion. The pathogeny and prognosis of cerebellar glioblastoma are still incompletely elucidated. CASE PRESENTATION: We report the case of a 19-year-old Moroccan woman. A neurologic examination revealed the presence of cerebellar signs. A diagnosis of cerebellar glioblastoma is rarely made before surgery. An encephalic computer tomography scan and magnetic resonance imaging increased the accuracy of defining the nature of the lesion. Magnetic resonance imaging showed a heterogeneously enhancing mass in the vermis and the right cerebellar hemisphere. After surgery, glioblastoma was histologically confirmed. Post-operative radiotherapy followed. The outcome of our patient was favorable after one year of follow-up. CONCLUSIONS: We report an unusual case of cerebellar gliobastoma. Cerebellar glioblastoma multiforme should be considered in the differential diagnosis of a cerebellar mass lesion.
RESUMO
Acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. We report an uncommon case of advanced pneumococcal meningitis complicated by acute lumbar epidural abscess in an adult. A 35-year-old man was admitted to the medical intensive care unit with pneumococcal meningitis. On the eighth day of hospitalization, he presented a cauda equine syndrome with flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction. Magnetic resonance imaging (MRI) of the spine demonstrated a suppurative collection at L2-L3. Surgical decompression was performed, and antibiotherapy was followed for eight weeks. Clinical improvement was progressive over eight months. New onset neurologic deficits in a patient with pneumococcal meningitis should raise suspicion of acute epidural abscess.
Assuntos
Abscesso Epidural/etiologia , Meningites Bacterianas/complicações , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Doença Aguda , Adulto , Diagnóstico Diferencial , Abscesso Epidural/diagnóstico , Humanos , Masculino , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/microbiologia , Infecções Pneumocócicas/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Intracranial epidermoid cysts are uncommon benign tumors of developmental origin; malignant transformation of benign epidermoid cysts is rare, and their prognosis remains poor. We report a case of squamous cell carcinoma arising in the cerebellopontine angle. A 52-year-old man presented with left facial paralysis and cerebellar ataxia. He had undergone total removal of a benign epidermoid cyst six months previously. Postoperative magnetic resonance imaging of the brain revealed a heterogeneous and cystic lesion in the left cerebellopontine angle with hydrocephalus. The cyst wall was enhanced by gadolinium. He underwent ventricle-peritoneal shunt and removal again; the histopathological examination revealed a squamous cell carcinoma possibly arising from an underlying epidermoid cyst. This entity is being reported for its rarity. The presence of contrast enhancement at the site of an epidermoid cyst combined with an acute, progressive neurological deficit should alert the neurosurgeon to the possibility of a malignant transformation.