Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of r...Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of rupture is linked to the volume of the malformation, its cortical location and venous drainage. In literature, few cases of rupture have been reported in cases of meningitis, but none are associated with a brain abscess. Objective: To report a case of an intraparenchymal hemorrhage due to rupture of an arteriovenous malformation with an associated brain abscess. Observation: The authors report the case of a 2-year-old child, admitted for impaired state of consciousness associated with a right hemiparesis and seizures in a febrile context. Clinical evaluation revealed a Blantyre score of 3, fever at 40˚C, divergent strabismus of the right eye, a right pyramidal syndrome and meningeal irritative syndrome. Cerebral CT scan revealed a left fronto-parietal intra-parenchymal hematoma and a right occipital ring-enhanced lesion, suggesting a brain abscess. An MRI suggested a probable rupture of an arteriovenous malformation resulting in the intra-parenchymal hematoma. Management consisted of craniotomy to evacuate the intra-parenchymal hematoma, antibiotic therapy with vancomycin and ceftriaxone at meningeal doses. Histopathological analysis of the intraoperative sample revealed an arteriovenous malformation. The postoperative course was marked by regression of hyperthermia, persistence of spasticity, irritability and clonic movement of the right lower limb. These were managed with baclofen, phenobarbital, and ergotherapy. We observed a regression of spasticity and improved motor skills in the right limbs. At 6 months follow-up, child could interact with his social environment despite aphasia, regression of spasticity and right hemiparesis. Conclusion: Rupture of arteriovenous malformations can be enhanced by neuro-meningeal infections and particularly brain abscesses. Cerebrovascular complications of these conditions mostly have unfavorable outcomes and neurological sequelae.展开更多
Introduction: Head injuries constitute a public health problem in Cameroon and everywhere else in the world. They represent 23% of admissions to the Yaounde emergency center (CURY), which is a center exclusively dedic...Introduction: Head injuries constitute a public health problem in Cameroon and everywhere else in the world. They represent 23% of admissions to the Yaounde emergency center (CURY), which is a center exclusively dedicated, since 2014, to emergency care in Yaounde. In the management of trauma brain injuries at CURY, several are operated on. However, to date, no evaluation of these operated patients has yet been made. Goals: The objective of this study was to highlight the prognostic factors in patients operated for TBI at CURY. Methodology: We conducted a descriptive study whose data collection was done retrospectively over 2 years (01 January 2021 to 31 December 2022) at CURY. Data was collected from the registers of operative reports. Results: We enrolled 105 medical reports of patients who were victims of TBI operated on. The male gender predominated with a sex ratio of 3/1. The average age of the patients was 37.5 ± 18.83 years. Public road accidents were the leading cause of TBI in 75.2% of cases. The means of transport of the victims were mostly non-medical 97.1%. 45.7% of patients were admitted in less than 6 hours following injury. The initial clinical evaluation found 45.8% of patients with a Glasgow Coma Score (GCS) between [14, 15], and 13.2% of patients had a GCS 8. The indications for surgery were extradural hematoma (30%), followed by acute subdural hematoma (24%). The major complication was postoperative infection (25%). The mortality rate of the series was 7.9%. Poor prognostic factors were the depth of the coma on admission, advanced age and postoperative complications. Conclusion: The results of this study suggest that most patients operated on for TBI at CURY had a favorable outcome. The poor prognostic factors were the depth of the coma on admission, advanced age, postoperative complications and comorbidities.展开更多
Introduction: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate crystals in and/or around joints, following long-standing hyperuricemia. This may cause gouty arthritis in join...Introduction: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate crystals in and/or around joints, following long-standing hyperuricemia. This may cause gouty arthritis in joints and tophi in soft tissues. Spinal gout is rare and never mentioned in our context. It can appear as acute back pain, radiculopathy, spinal cord compression, spondylodiscitis or neoplasic/infectious epiduritis. Our aim was to share our surgical experience and proceed of a Literature review. Cases Presentation: Between January and August 2022, two patients male were surgically cared, aged of 42 and 60 years old. The gout was unknown in the youngest and poorly followed in the eldest. There was no past medical history of tuberculosis or immunodeficiency in both. The early diagnosis retained was unspecific lumbar spondylodiscitis due to clinical features: Patients complained both of lower back pain with initial fever. It was of a progressive left L5S1 deficit with erectile defect and dysuria in the first case and a progressive paraplegia without sphincter disorders in the second case. We proceeded with a lumbar laminectomy with a biopsy on both patients. The spinal tophus was ligamentous in one case and arthro-ligamentous in the other. There was a progressive motor recovery from postoperative Day-2 till postoperative Month-1. A probabilistic antituberculosis treatment was promptly initiated postoperatively based on radioclinic features while waiting for histologic proof. The Polymerase Chain Reaction (PCR) of Mycobacterium tuberculosis was negative and the histology was of a chronic calcified osteitis with dense fibrosis in both. The anti-gout treatment was implemented after 15 days with blood test evidence. A rheumatologic follow-up was also initiated and adjuvant physio-therapy. The results were very satisfactory from 4 - 6 months with independent walking. Discussion Conclusion: Spinal Gout may be suggested in 40-male-old faced with any acute rachialgia with neuro deficit with dubious neuro-imaging.展开更多
文摘Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of rupture is linked to the volume of the malformation, its cortical location and venous drainage. In literature, few cases of rupture have been reported in cases of meningitis, but none are associated with a brain abscess. Objective: To report a case of an intraparenchymal hemorrhage due to rupture of an arteriovenous malformation with an associated brain abscess. Observation: The authors report the case of a 2-year-old child, admitted for impaired state of consciousness associated with a right hemiparesis and seizures in a febrile context. Clinical evaluation revealed a Blantyre score of 3, fever at 40˚C, divergent strabismus of the right eye, a right pyramidal syndrome and meningeal irritative syndrome. Cerebral CT scan revealed a left fronto-parietal intra-parenchymal hematoma and a right occipital ring-enhanced lesion, suggesting a brain abscess. An MRI suggested a probable rupture of an arteriovenous malformation resulting in the intra-parenchymal hematoma. Management consisted of craniotomy to evacuate the intra-parenchymal hematoma, antibiotic therapy with vancomycin and ceftriaxone at meningeal doses. Histopathological analysis of the intraoperative sample revealed an arteriovenous malformation. The postoperative course was marked by regression of hyperthermia, persistence of spasticity, irritability and clonic movement of the right lower limb. These were managed with baclofen, phenobarbital, and ergotherapy. We observed a regression of spasticity and improved motor skills in the right limbs. At 6 months follow-up, child could interact with his social environment despite aphasia, regression of spasticity and right hemiparesis. Conclusion: Rupture of arteriovenous malformations can be enhanced by neuro-meningeal infections and particularly brain abscesses. Cerebrovascular complications of these conditions mostly have unfavorable outcomes and neurological sequelae.
文摘Introduction: Head injuries constitute a public health problem in Cameroon and everywhere else in the world. They represent 23% of admissions to the Yaounde emergency center (CURY), which is a center exclusively dedicated, since 2014, to emergency care in Yaounde. In the management of trauma brain injuries at CURY, several are operated on. However, to date, no evaluation of these operated patients has yet been made. Goals: The objective of this study was to highlight the prognostic factors in patients operated for TBI at CURY. Methodology: We conducted a descriptive study whose data collection was done retrospectively over 2 years (01 January 2021 to 31 December 2022) at CURY. Data was collected from the registers of operative reports. Results: We enrolled 105 medical reports of patients who were victims of TBI operated on. The male gender predominated with a sex ratio of 3/1. The average age of the patients was 37.5 ± 18.83 years. Public road accidents were the leading cause of TBI in 75.2% of cases. The means of transport of the victims were mostly non-medical 97.1%. 45.7% of patients were admitted in less than 6 hours following injury. The initial clinical evaluation found 45.8% of patients with a Glasgow Coma Score (GCS) between [14, 15], and 13.2% of patients had a GCS 8. The indications for surgery were extradural hematoma (30%), followed by acute subdural hematoma (24%). The major complication was postoperative infection (25%). The mortality rate of the series was 7.9%. Poor prognostic factors were the depth of the coma on admission, advanced age and postoperative complications. Conclusion: The results of this study suggest that most patients operated on for TBI at CURY had a favorable outcome. The poor prognostic factors were the depth of the coma on admission, advanced age, postoperative complications and comorbidities.
文摘Introduction: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate crystals in and/or around joints, following long-standing hyperuricemia. This may cause gouty arthritis in joints and tophi in soft tissues. Spinal gout is rare and never mentioned in our context. It can appear as acute back pain, radiculopathy, spinal cord compression, spondylodiscitis or neoplasic/infectious epiduritis. Our aim was to share our surgical experience and proceed of a Literature review. Cases Presentation: Between January and August 2022, two patients male were surgically cared, aged of 42 and 60 years old. The gout was unknown in the youngest and poorly followed in the eldest. There was no past medical history of tuberculosis or immunodeficiency in both. The early diagnosis retained was unspecific lumbar spondylodiscitis due to clinical features: Patients complained both of lower back pain with initial fever. It was of a progressive left L5S1 deficit with erectile defect and dysuria in the first case and a progressive paraplegia without sphincter disorders in the second case. We proceeded with a lumbar laminectomy with a biopsy on both patients. The spinal tophus was ligamentous in one case and arthro-ligamentous in the other. There was a progressive motor recovery from postoperative Day-2 till postoperative Month-1. A probabilistic antituberculosis treatment was promptly initiated postoperatively based on radioclinic features while waiting for histologic proof. The Polymerase Chain Reaction (PCR) of Mycobacterium tuberculosis was negative and the histology was of a chronic calcified osteitis with dense fibrosis in both. The anti-gout treatment was implemented after 15 days with blood test evidence. A rheumatologic follow-up was also initiated and adjuvant physio-therapy. The results were very satisfactory from 4 - 6 months with independent walking. Discussion Conclusion: Spinal Gout may be suggested in 40-male-old faced with any acute rachialgia with neuro deficit with dubious neuro-imaging.
