Debilitating genitofemoral neuralgia due to nerve entrapment after appendectomy: A case report.

Genitofemoral (GF) neuralgia refers to pain and sensory complaints in the region innervated by the GF nerve. It is a rarely reported condition, often due to iatrogenic causes following inguinal surgeries. In refractory forms, diagnostic reassessment is required to look for possible entrapment of the GF nerve. Here we describe a patient who underwent appendectomy and subsequently developed severe debilitating pain in the region of the right GF nerve. Our patient underwent a second laparoscopic surgery with clip removal, resulting in rapid recovery.

Delusional Infestation in Parkinson's Disease Secondary to Piribedil Escalation: An Uncommon Case Report.

Delusional infestation (DI) is characterized by delusions of being infested by small microorganisms or even inanimate objects without any medical or microbiological evidence. The pathophysiology of DI is not well understood, and there are two types of DI: the primary form, where there is no underlying cause, and the secondary form, which is related to an associated psychiatric disorder, medical condition, or substance use. DI in Parkinson's disease (PD) is rarely reported, and most published cases are due to antiparkinsonian drugs. Piribedil is a dopaminergic agonist used for the symptomatic treatment of PD either as monotherapy or as adjuvant therapy with other antiparkinsonian treatments. We report the case of an 81-year-old man followed for PD at our institution who developed DI after piribedil dose escalation. When DI is secondary to an antiparkinsonian drug, the treatment of choice is based on withdrawing the implicated drug.

Anxiety and Depressive Symptoms in Moroccan Patients Following Major Lower Limb Amputation: A Three-Month Follow-Up.

OBJECTIVE: Major amputation of a lower limb is a traumatic experience that causes physical and psychosocial disabilities. This study set out to ascertain how anxiety and depression symptoms changed during the three months following the amputation. MATERIALS AND METHODS: A prospective longitudinal observational study was conducted between October 1, 2019, and January 1, 2021, in the Department of Vascular Surgery and the Department of Orthopedic Traumatology of the Ibn Sina Hospital Center in Rabat, Morocco. The study assesses symptoms of anxiety and depression in patients who have undergone a major lower limb amputation over a three-month interval. RESULTS: In patients who had undergone a major lower limb amputation, the prevalence of anxiety and depression symptoms was very high immediately postoperatively (47.4% and 79.2%, respectively), with a significant decrease in these symptoms. Three months later, anxiety was reported in 24.4% of cases, and depressive symptoms in 65.1% of cases. Age, amputation level, stump pain, phantom limb pain, re-amputation, and emergency amputation were all associated with an increased risk of anxiety and depression. The patient's psychological preparation prior to the amputation, the anesthetic technique used during the procedure, the patient's mobility, and the patient's post-amputation professional status were all protective factors. CONCLUSION: Our research findings bolster the necessity of promptly evaluating and managing anxiety and depression in the initial three months following major lower limb amputation. Thus, we believe that amputee patients ought to receive a formal psychological evaluation, which could be helpful, particularly for those whose anxiety or depression symptoms did not improve after three months.

Artery of Percheron infarction presented with isolated downgaze paralysis: A case report.

Isolated downgaze paralysis is the most infrequent expression of vertical gaze abnormalities. Vertical eye movements are controlled by nuclei and circuits located in the thalamic-mesencephalon region, and more particularly the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). The Artery of Percheron (AP) is a rare vascular anatomic variation that supplies the paramedian region of the thalami and the rostral portion of the mesencephalon. We present a unique case of isolated downgaze paralysis caused by AP ischemia.

Cerebral venous thrombosis secondary to ulcerative colitis: A case report with a literature review.

Ulcerative colitis is an idiopathic inflammatory bowel condition that may be worsened by thromboembolic events such deep vein thrombosis, cerebral venous thrombosis, and pulmonary embolism. Cerebral venous thrombosis is a rare but critical consequence of ulcerative colitis characterized by high mortality and morbidity rate. It is thought to be caused by the hypercoagulable state that occurs during ulcerative colitis relapse. Cerebral venous thrombosis is a reversible condition with good outcomes when detected early and treated properly. In this study, we describe the case of a young woman who presented with cerebral venous thrombosis secondary to ulcerative colitis complicated by venous infarction with petechial cerebral hemorrhage.

Neuromeningeal tuberculosis in HIV-negative patients: a retrospective study in Rabat, Morocco.

Neuro-Meningeal Tuberculosis (NMT) is a severe infection of the central nervous system which causes a public health problem in Morocco and in several countries in the world. In order to describe the epidemiological, clinical, paraclinical and outcome among NMT patients without HIV, we carried out a retrospective study at the neurology department of the Military Hospital of Rabat in Morocco, over a period of 17 years (2000-2017). Forty patients were included with a mean age of 44 years (± 18) and a sex ratio of 1.66. A history evoking the possibility of tuberculous origin was found in 8 patients (20%). Febrile confusion was the most common clinical manifestation and was observed in 22 patients (55%) followed by febrile meningeal syndrome in 12 patients (30%). The main abnormalities noted in brain magnetic resonance imaging (MRI) were: hydrocephalus in 13 cases (32.5%), intra-cranial tuberculomas in 10 patients (25%) and leptomeningitis in 9 cases (22.5%). Cerebrospinal fluid study found clear aspect in 29 patients (75%), direct acid fast bacilli smear examination was positive in 4 patients (10%) and positive culture in 4 patients (10%). The Polymerase chain reaction (PCR) study returned positive in 6 patients (35%) of the 17 patients tested. The outcome was good in 18 patients (45%) while 19 patients suffered from neurological sequelae (47.5%) and 3 cases of death recorded (7.5%). Febrile confusion was the most reported manifestation in our patients. Subacute onset of symptoms was the most predominant feature in our patients as reported in the literature. Our results are consistent with the literature and confirm the severity of this infectious disease, even in HIV-negative patients.

Accessory spinal nerve damage during a cervical lymph node biopsy: case report.

The lesion of the accessory spinal nerve is often of iatrogenic origin. We report the case of an injury after a right jugulocarotid lymph node biopsy. A 30-year-old patient was referred for the treatment of right cervical lymphadenopathy suspected of tuberculosis. After the intervention and confirmation of tuberculosis diagnosis, the patient presented a functional impotence of the right shoulder and swarming of the right hand. The clinical examination found an active limitation of the shoulder, and a wasting of the upper bundle of the right trapezius muscle and the sternocleidomastoid. The EMG showed axonotmesis of the accessory spinal nerve and the MRI an amyotrophy of the trapezius with denervation edema. A simple rehabilitation has been scheduled. Damage of the accessory spinal nerve most often occurs after local surgery. EMG is essential for diagnosis. Rehabilitation is the first therapeutic option. Surgery can be considered if it fails. The surgeons must consider the protection of the accessory spinal nerve in case of cervical lymph node surgery.

Brucellosis: A cause of meningitis not to neglect.

Brucellosis is the most frequent bacteria zoonosis in the world, with more than half a million new cases each year [1]. It is also the most significant zoonos in the edge of the Mediterranean Sea [2]. This zoonosis is capable of affecting humans and cause polymorphic clinical manifestations. In Morocco, the southern regions are the main affected areas [3]. We are reporting the observation of a 17-year-old male patient, who presented a febrile meningeal syndrome for 9 months without sensitivo-motor deficit. Tuberculosis is frequently evoked in such clinical presentations because Morocco is an endemic country, brucellosis is therefore often forgotten. The results of lumbar puncture, magnetic resonance imaging (MRI) and especially serology aided to conclude to a neuro-brucellosis. The outcome was favourable with antibiotic therapy.