Introduction: Extradural hematoma is a common pathology in our department. The natural history of small-volume hematoma is usually towards resorption. In rare cases, the hematoma calcifies and compresses the brain. We...Introduction: Extradural hematoma is a common pathology in our department. The natural history of small-volume hematoma is usually towards resorption. In rare cases, the hematoma calcifies and compresses the brain. We report an extradural hematoma in a 15-year-old boy who had a road traffic accident on February 2011. The brain CT-scan performed the following day revealed a small right frontal extradural hematoma. During hospitalization, he had a fever of 40 degrees with convulsions and the blood culture isolated the coagulase-negative staphylococci and Group D streptococci. When his conscience was restored, hemiparesis and dysarthria were observed. The control brain CT-scan performed 2 weeks after the trauma showed early resorption of the hematoma. Two months after the trauma, the brain CT-scan showed calcification of the hematoma. He underwent surgery in April 2011 to remove the calcification. The sequels were hemiparesis and posttraumatic epilepsy. Conclusion: The evolution of a small non-operated extradural hematoma can be done towards calcification thus requiring surgery.展开更多
The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We ...The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.展开更多
Anterior cervical spine surgery for traumatic or degenerative disease is a well-established procedure. However, complications such as pharyngoesophageal perforation can occur. In this study, we report a series of 6 ph...Anterior cervical spine surgery for traumatic or degenerative disease is a well-established procedure. However, complications such as pharyngoesophageal perforation can occur. In this study, we report a series of 6 pharyngoesophageal perforations after surgery. Based on the literature review, we analyzed pathogenesis, diagnosis and discussed therapeutic strategies. Three cases occurred after surgeries of traumatic cervical spine whereas the remaining were after surgeries for degenerative cervical myelopathy. The mean duration of surgery was 210 minutes. The symptoms, appearing 48 hours after surgery, were commonly hyperthermia, dysphagia, sore throat and swelling of the incision site. The diagnostic was confirmed after contrast-enhanced esophagography. The treatment strategies consisted of insertion of nasogastric feeding tube, oral intake restriction, intravenous antibiotics administration, wound drainage. Reoperation was necessary in 4 cases with removal of the hardware in three of them. One death occurred by pulmonary embolism in a tetraplegic patient. The occurrence of pharyngoesophageal perforation after cervical spine surgery can be disastrous. It can be avoided by increasing surgeon awareness during the surgical procedure. Early detection, immediate and multidisciplinary therapy are recommended to achieve the best outcomes.展开更多
Congenital skull fractures of newborn are rare and create medico-legal problems. Their management is controversial. Between surgery considered too aggressive and uncertain conservative attitude, reduction by suction c...Congenital skull fractures of newborn are rare and create medico-legal problems. Their management is controversial. Between surgery considered too aggressive and uncertain conservative attitude, reduction by suction cup or breast pump is an alternative. The authors report their experience through a case of successful resolution of a congenital depressed skull fracture using a suction cup in a newborn at 13 day of life followed by a literature review. This technique avoids the usual complications of surgery and reduces the anxiety of parents related to surgery. It also avoids the anxiety of having a newborn with a recessed skull and a conservative attitude with uncertain outcome.展开更多
Multifocal skeletal tuberculosis is a rare condition. The diagnosis is difficult and the treatment is delayed in the vast majority of cases. A 30-year-old immunocompetent jobless male complained of thoracic and lumbar...Multifocal skeletal tuberculosis is a rare condition. The diagnosis is difficult and the treatment is delayed in the vast majority of cases. A 30-year-old immunocompetent jobless male complained of thoracic and lumbar spine pain for several weeks, associated with progressive weight loss without fever. Neurological examination was normal. CT scanning demonstrated hypodense multifocal lesions of the spine and the hip. Vertebroplasty was performed successfully. But a pathological examination of the biopsy of spinal lesions was not conclusive. One month later, the patient developed an acute spinal cord compression syndrome. Emergency decompression surgery was performed, which demonstrated the purulent epidural abscess and osteolysis. The pathological examination was in favor of tuberculosis. Despite surgical stabilization and cementoplasty, anti-TB therapy and kinesitherapy, the patient was still significantly limited a few months later with a flaccid paraplegia. TB infection was cleared at the end of the two-phase regimen. Atypical tuberculosis ormultifocal TB poses diagnostic problems especially with metastases, malignant lymphoma, and multiple myeloma. We report this rare case of mutifocal skeletal tuberculosis to show the place of vertebroplasty in the management of spinal tuberculosisor if there is indeed a potential role that vertebroplasty could have played in spreading spinal lesions. The patient was informed that non identifying information from the case would be submitted for publication, and he provided consent.展开更多
文摘Introduction: Extradural hematoma is a common pathology in our department. The natural history of small-volume hematoma is usually towards resorption. In rare cases, the hematoma calcifies and compresses the brain. We report an extradural hematoma in a 15-year-old boy who had a road traffic accident on February 2011. The brain CT-scan performed the following day revealed a small right frontal extradural hematoma. During hospitalization, he had a fever of 40 degrees with convulsions and the blood culture isolated the coagulase-negative staphylococci and Group D streptococci. When his conscience was restored, hemiparesis and dysarthria were observed. The control brain CT-scan performed 2 weeks after the trauma showed early resorption of the hematoma. Two months after the trauma, the brain CT-scan showed calcification of the hematoma. He underwent surgery in April 2011 to remove the calcification. The sequels were hemiparesis and posttraumatic epilepsy. Conclusion: The evolution of a small non-operated extradural hematoma can be done towards calcification thus requiring surgery.
文摘The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.
文摘Anterior cervical spine surgery for traumatic or degenerative disease is a well-established procedure. However, complications such as pharyngoesophageal perforation can occur. In this study, we report a series of 6 pharyngoesophageal perforations after surgery. Based on the literature review, we analyzed pathogenesis, diagnosis and discussed therapeutic strategies. Three cases occurred after surgeries of traumatic cervical spine whereas the remaining were after surgeries for degenerative cervical myelopathy. The mean duration of surgery was 210 minutes. The symptoms, appearing 48 hours after surgery, were commonly hyperthermia, dysphagia, sore throat and swelling of the incision site. The diagnostic was confirmed after contrast-enhanced esophagography. The treatment strategies consisted of insertion of nasogastric feeding tube, oral intake restriction, intravenous antibiotics administration, wound drainage. Reoperation was necessary in 4 cases with removal of the hardware in three of them. One death occurred by pulmonary embolism in a tetraplegic patient. The occurrence of pharyngoesophageal perforation after cervical spine surgery can be disastrous. It can be avoided by increasing surgeon awareness during the surgical procedure. Early detection, immediate and multidisciplinary therapy are recommended to achieve the best outcomes.
文摘Congenital skull fractures of newborn are rare and create medico-legal problems. Their management is controversial. Between surgery considered too aggressive and uncertain conservative attitude, reduction by suction cup or breast pump is an alternative. The authors report their experience through a case of successful resolution of a congenital depressed skull fracture using a suction cup in a newborn at 13 day of life followed by a literature review. This technique avoids the usual complications of surgery and reduces the anxiety of parents related to surgery. It also avoids the anxiety of having a newborn with a recessed skull and a conservative attitude with uncertain outcome.
文摘Multifocal skeletal tuberculosis is a rare condition. The diagnosis is difficult and the treatment is delayed in the vast majority of cases. A 30-year-old immunocompetent jobless male complained of thoracic and lumbar spine pain for several weeks, associated with progressive weight loss without fever. Neurological examination was normal. CT scanning demonstrated hypodense multifocal lesions of the spine and the hip. Vertebroplasty was performed successfully. But a pathological examination of the biopsy of spinal lesions was not conclusive. One month later, the patient developed an acute spinal cord compression syndrome. Emergency decompression surgery was performed, which demonstrated the purulent epidural abscess and osteolysis. The pathological examination was in favor of tuberculosis. Despite surgical stabilization and cementoplasty, anti-TB therapy and kinesitherapy, the patient was still significantly limited a few months later with a flaccid paraplegia. TB infection was cleared at the end of the two-phase regimen. Atypical tuberculosis ormultifocal TB poses diagnostic problems especially with metastases, malignant lymphoma, and multiple myeloma. We report this rare case of mutifocal skeletal tuberculosis to show the place of vertebroplasty in the management of spinal tuberculosisor if there is indeed a potential role that vertebroplasty could have played in spreading spinal lesions. The patient was informed that non identifying information from the case would be submitted for publication, and he provided consent.
