[Os odontoideum: clinical and radiological aspects]

Few reports of os odontoideum have been made. We report two cases where this affection was revealed by cervical pain and hemiparesis in one case and acute tetraparesis in the other. Patients with os odontoideum usually present with neurological signs, but some have only cervical pain and some others remain asymptomatic. Radiological exams, including radiograms, cervical scanner and MRI lead to the diagnosis. Different surgical treatment can be proposed to symptomatic patients. Prophylactic surgical treatment is not indicated.

[Maffucci syndrome: an historical case]

We report a case of Maffucci syndrome in a 24-year-old patient, diagnosed thanks to the data of the clinical examination, the imagery and the histology. The clinical, radiological and evolutionary aspects are discussed, as well as the various therapeutic means.

[Kahler's disease presenting with a solitary cranial vault plasmacytoma]

INTRODUCTION

Solitary plasmocytoma is rarely located in the cranial vault. Usually observed, in elderly patients, occurrence during adolescence is extremely rare. We report the case of a 16-year-old patient presenting a cranial vault solitary plasmocytoma which revealed Kahler disease.

CASE REPORT

A 16-year-old patient consulted for a frontal tumefaction becoming painful with diplopia. The cranio-encephalic radiography and the MRI showed a tumoral process involving cranial vault; biopsy revealed a solitary plasmocytoma. Search for multiple myeloma was negative. Six months later, a disease of Kahler was declared.

CONCLUSION

Clinical and biological follow-up of cranial plasmocytoma is necessary, because progression to multiple myeloma is possible as in our observation. Imaging and particularly MRI are needed to specify the axial seat of the tumoral process and its relationship with the nervous and vascular structures.

Neuro-imagerie de la sclérose tubéreuse de Bourneville

Tuberous sclerosis is a phakomatosis with central nervous system manifestations characterized by 4 lesions detectable on neuro-imaging: tubers, white matter abnormalities, subependymal nodules and subependymal astrocytomas. The first three are benign lesions composed of by identical cytological lesions varying only in size and location. At CT, enhancement of subependymal nodules is usually considered as evidence of transformation to subependymal giant cell astrocytoma. This latter poses the problem of its relative benignity: hydrocephalus source of morbidity or even mortality. From a series of 22 cases, the authors review the characteristics of these abnormalities.

[Occipital osteosarcoma of a 33 years old man: a case report]

Cranial localization of osteosarcoma is rare, representing only 0,7-3% of cranial primary tumours. The authors present the case of a 33 year old man with occipital osteosarcoma diagnosed by CT scan, MRI and angiography. The radiological features of this pathology are discussed.

Ankylose de l’articulation temporo-mandibulaire : rare manifestation de la spondylarthrite ankylosante

INTRODUCTION

The ankylosing spondylitis is a chronic inflammatory rheumatoid disease with predilection in the axial structures. The temporomandibular joint (TMJ) is involved in 10 to 24% of cases. Ankylosis of the TMJ is exceptional, only 11 cases being reported to date.

OBSERVATION

A 48-year-old patient had been followed since 1987 for severe ankylosing spondylitis. The patient, known to be positive for tissue antigen HLA B27, was admitted for limitation of mouth opening. At physical examination, mouth opening was reduced to 1cm with no mandibular movements and a stiffness of the cervical spine in flexion. Computed tomography of the TMJs highlighted a bilateral lesion with ankylosis of the left joint and of C1-C2. Surgical treatment consisted in block resection of the two TMJs using a cartilaginous rib. With a follow up of 9 months, results have been satisfactory.

DISCUSSION

Complementary explorations should be undertaken in ankylosing spondylitis patients with clinical symptoms suggestive of TMJ lesions in order to establish the diagnosis and initiate treatment and avoid the development of ankylosic forms.

[Candida arthritis of the TM joint complicating chronic otitis media]

Infectious arthritis of the temporomandibular joint is very uncommon, and arthritis of the TM joint as a result of candida albicans infection has not previously been reported. The authors describe a patient treated for chronic otitis media complicated by arthritis of the temporomandibular joint. The diagnosis was made using CT scan and bacteriologic sampling.

[MRI appearance of lumbar epidural abscesses: report of three cases]

The authors report three cases of non-tuberculous epidural abscess. Presenting symptoms included lumbar back pain, muscle spasms, soft tIssue swelling, and neurological deficits in all three cases. MR imaging was helpful for diagnosis and showed involvement of perivertebral soft tissues and an epidural abscess of variable size. There was no significant involvement of intervertebral disks or vertebrae. Diagnosis was confirmed by bacteriologic exam. Clinical outcome was favourable with antibiotic treatment.

[Intracranial textiloma]

The authors report a case of intracranial textiloma in a 36-year-old male diagnosed 3 years after surgery for a left spheno-orbital meningioma.

[Superficial vascular anomalies of the face: apropos of six cases]

The classification of superficial vascular anomalies of the face recognizes two major categories: hemangiomas and vascular malformations. A multidisciplinary approach to these malformations is necessary. MRI of venous vascular malformations, pulsed Doppler and arteriography of arteriovenous malformations are key examinations in the exploration strategy for superficial vascular malformations. Hemangiomas always regress. Surgery is generally needed only for late sequelae although in some cases early surgery is beneficial. Percutaneous sclerotherapy and surgery are indicated for venous malformations in order to minimize or improve skin, muscle and bone distorsions. Arteriovenous malformations are the most dangerous vascular anomalies of the face. Superselective arterial embolization prepares the surgical excision of the nidus, complete resection is essential. We review 6 cases of superficial vascular malformations of the face treated surgically and discuss the diagnosis features and the treatment modalities of these vascular anomalies.

[A rare cause of spinal cord compression: osteochondroma of the thoracic spine. A case report]

Osteochondroma or exostosis is the most common benign tumor of bone, but vertebral involvement is rare. The authors report the case of a 16 years old male with a family history of hereditary multiple exostoses who presented with spinal cord compression. MR examination showed an intraspinal extradural bone lesion at the T1-T2 level, hyperintense on T1 weighted and hypointense on T2 weighted images, causing marked cord deformity. The CT scan showed a tumor of the body and left pedicle of T2 with severe narrowing of the spinal canal.

[The piriformis syndrome: a rare cause of non discogenic sciatica. A case report]

Atypical sciatic pain without apparent discogenic origin should raise the possibility of a non-discogenic etiology, especially tumoral but also infectious or inflammatory. We report the case of a young patient presenting with non-discogenic S1 radiculopathy due to sciatic nerve involvement in the subpiriformis canal secondary to piriformis muscle inflammation. The authors review technical considerations and results of MRI which is of great value in the evaluation of piriformis muscle pathology.

[Traumatic false aneurysms of intracranial artery]

The authors report a case of intracranial traumatic aneurysm at young a 21 years old patient. He presented with recurrent epistaxis 3 months after craniofacial trauma. An aneurysm of the left carotid artery was diagnosed at cerebral angiography. Endovascular treatment was performed with favorable outcome. In spite of their rarity, posttraumatic intracranial aneurysms should be suspected in patients with recent or remote history of trauma, even minor, presenting with secondary clinical deterioration, in order to carry out emergent angiographic exploration, before contemplating definitive surgical or endovascular treatment.

[Primary intradural extramedullary hydatidosis. Case report and review of the literature]

The authors report a case of cauda equina compression by intradural hydatid cyst. An 18-year-old man presented with paraparesis and sphincter dysfunction. MRI showed an intradural cystic lesion extending from L1 to L2 with low signal intensity on T1 and high signal intensity on T2. The cyst was removed after laminectomy and opening of the dural sac. Histological and parasitic examinations confirmed a diagnosis of hydatid cyst. The patient improved progressively after surgery. The similar 22 cases of intradural extramedullary hydatid disease reported in the literature were reviewed. All spinal areas were involved, with a predilection for the thoracic region. Neurological complications were usual with rapid spinal cord compression in this rare form of hydatid disease. The treatment was by surgery with a favourable outcome compared to the classic hydatid cyst of the spine.

[Tuberculosis of the posterior vertebral arch. A case report]

Tuberculosis of the spine usually involves the vertebral body and intervertebral disk. Involvement of the posterior arch is rare. We report a case of tuberculosis involving the posterior elements of the T4 and T5 vertebrae in a 38 year old woman. CT is helpful to assess bony structures whereas MRI is ideal to evaluate the neural structures. Clinical, radiographic, and therapeutic considerations regarding tuberculosis of the spine are reviewed.

[CT and MRI features of spinal hydatidosis. A report of 8 cases]

PURPOSE

Hydatidosis affects the bone in 0.5 to 2% of cases, with 44% of these cases involving the spine. We report 8 cases of vertebral involvement evaluated by CT and/or MRI. Materials and Methods. This retrospective study from January 1996 to August 2000 included seven patients (5 men and 3 women) aged between 28 and 65 years old. The mean age was 45 years old. Five patients underwent CT scan (one by CT-myelography). MRI was available in 4 cases.

RESULTS

Imaging showed multicystic bony lesions. Thoracic involvement was present in 4 cases, lumbar involvement in 2 cases, and sacral involvement in 2 cases. The process involved 2 adjacent vertebrae in 4 cases at the thoracic and lumbar levels and the entire sacrum in the other cases. Only one case of vertebral collapse was noted, but extension into the spinal canal was noted in all cases. Other sites of involvement were also noted, especially in adjacent soft tissues, liver and spleen.

CONCLUSION

The presence of multicystic vertebral lesions with involvement of adjacent soft tissues and/or distant organs should raise the possibility of spinal hydatidosis in endemic countries.

[An unusual cerebral hydatid cyst]

Hydatid cysts of the brain are very rare. Typically, the cyst is large, spherical, with sharply defined borders. Its may calcify, and there is no surrounding edema and no rim enhancement. Sometimes, one side of the cyst wall is very close to the calvarium, with thinning of the internal table. We report a case of hydatid cyst of the brain with particular scanographic signs, bilobular with thin membranes in the posterior component. There was a destruction of the opposite calvarium with exteriorisation into hypodermic soft tissue.

[A rare primitive neuroectodermal tumor: the medulloepithelioma]

Primitive neuroectodermal tumors (PNET) is a name used to describe rare and highly malignant tumors composed of undifferentiated cells resembling germinal or matrix cells of the embryonic neural tube. These tumors occur most commonly in the first decade of life, and have a particular radiological, histological and evolution features. We report a case of a PNET in an 8-year-old boy who presented intracranial hypertension studied with computed tomography scan, which demonstrated a sharply circumscribed expansive mass in the frontoparietal deep white matter, with a large cystic component, which was considered at first as a glial tumor. It was treated by total excision, and the histologic study demonstrated a medulloepithelioma. We studied the concept of PNET and their pathological, radiological and prognostic features.

[Syphilitic spinal cord gumma]

Syphilitic spinal cord gumma Syphilitic gummas of the central nervous system are exceptional and are in general described in the brain. We report the case of a Brown-Sequard syndrome in a 25-year-old patient. The cervical myelography and the brain CT as well as the vertebro-occipital junction were normal. The diagnosis of multiple sclerosis was evoked and corticosteroid therapy was initiated. The patient experienced clinical improvement. Two years later, the patient was readmitted. Immunological reactions for syphilis were positive, in serum and CSF. Tests for HIV were negative. The MRI showed a cervical spinal cord process at the C3 level with adhesive spinal associated arachnoiditis. Penicillin therapy was started prior to surgery for the spinal process. The syphilitic nature was confirmed by pathology. To our knowledge, the MR appearance of a syphilitic gumma of the spinal cord has not been described previously in the scientific literature.

[Sub-occipital Pott's disease. Diagnostic imaging in 2 cases]

Pott's disease is the most common form of bone and joint tuberculosis, notably in the thoracolumbar spine. The sub-occipital localization remains exceptional, raising a major risk of spinal instability and severe bulbo-medullary complications. We report 2 new cases of tuberculous spondylodiscitis at the cervico-occipital junction revealed by signs of spinal compression associated with torticolis and dysphagia. The diagnosis was provided by CT scan and MR imaging and was confirmed histologically on a transoral biopsy of the retropharyngeal abscess. The patients were successfully treated with antituberculosis drugs combined with external stabilization of the spine. The diagnostic aspects, notably the neuroradiological findings in this particular localization of Pott's disease are recalled.