[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.

[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.

[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.

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.

Cerebral venous thrombosis revealing an ulcerative colitis.

Cerebral venous thrombosis (CVT) has been reported as an uncommon and devastating complication of ulcerative colitis (UC), with an annual incidence varying between 0,5 to 6,7%. It is suspected to be a consequence of the hypercoagulable state occurring during disease relapse. We report a case of 22-year-old female patient presenting with CVT revealing an UC. Our case raises the awareness among health professionals about the inflammatory bowel diseases (IBD) as a rare etiology of CVT, and signifies the importance of considering antithrombotic prophylaxis in all hospitalised IBD patients, especially those with active disease.

[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.