Ischemic stroke secondary to radiation-induced carotid artery stenosis

INTRODUCTION

Large vessel vasculopathy, such as carotid stenosis, has been shown to be a side effect of radiotherapy (RT) and has received increasing attention especially in recent decades with the improvement of RT technology. These injuries can lead to a higher risk of cerebrovascular events such as ischemic stroke. The management of these lesions may be performed with surgical repair but also with endovascular technique.

OBSERVATION

A 61-year-old man was admitted to the emergency department for an acute ischemic stroke. He was treated 16years prior for laryngeal tumor for which he had received 23 sessions of radiation therapy at the dose of 60Gy per session. The CT scan showed a radiation-induced stenosis of the right internal carotid artery with thrombosis of the right anterior cerebral artery and the right middle cerebral artery. The patient was treated with angioplasty of the right internal carotid artery with good outcome.

CONCLUSION

Radiation-induced vasculopathy of the carotid artery has gained relevance in patients with head and neck neoplasms. These vascular lesions are associated with the risk of late cerebrovascular events.

Management of a recurrent stroke due to a carotid web

Carotid web is a rare intraluminal parietal protrusion in the carotid artery. This vascular anomaly mostly occurs at the bifurcation causing turbulent flow, and is responsible of thrombi formation associated with embolic ischemic events. We report the case of a 35-year-old woman, with no medical history, who presented a recurrent middle cerebral artery (MCA) occlusion within twelve hours caused by a carotid bulb web. Although considered as a rare entity, carotid web is associated with the risk of recurrent strokes in the MCA territory and especially in the absence of the typically recognized risk factors. The key imaging is the CT angiography that shows the web, the cerebral artery occlusion, and the outcome appreciation. Therapeutic strategy associates antithrombotic treatment and operative management with stenting of the carotid web or endarterectomy.

Recurrent floating common carotid artery thrombus related to COVID-19: a case report

The occurrence of arterial and venous thrombosis during coronavirus infection has been widely reported since the beginning of the epidemic. Floating carotid thrombus (FCT) in the common carotid artery is exceptional, and its main known cause is atherosclerosis. We describe the case of a 54-year-old man who developed, one week after the onset symptomatology of related to COVID-19 infection, an ischemic stroke, complicating a large intraluminal floating thrombus in the left common carotid artery. Despite surgery and anticoagulation, a local recurrence with other thrombotic complications occurred and the patient died.

Post-traumatic pseudoaneurysm of temporo-maxillary trunk in a child: A case report

Post-traumatic pseudoaneurysm of branches of external carotid artery is very rare and is at high risk of engaging vital prognosis by a rupture, even more in child. So, it must be evoked in emergency in front of any beating mass after a local trauma. We report the case of a 14-year-old child with a pseudoaneurysm of the temporo-maxillary trunk that occurred after a local trauma. The diagnosis was based on clinical examination and angio-MRI. The treatment was hybrid. After an embolization of the arterial trunk we performed a surgical flattering of the pseudoaneurysm and suture of maxillary and temporal orifices.

Unusual presentation of parotid gland adenoid cystic carcinoma : A case presentation and literature review

Adenoid cystic carcinoma (ACC) represents approximately 10% of all epithelial salivary neoplasms and most commonly involves the parotid gland. We report CT and MRI finding of a 38-year-old young man presented to our ENT department with 02 years history of an external auditory canal stenosis. Physical examination revealed bilateral parotid gland swelling with a complete stenosis of the left external auditory canal. Temporal bone contrast enhanced CT-SCAN revealed is an isodense enhancing mass measuring 4 cm involving posterior and inferior external auditory canal wall, and invading the superficial lobe of the homolateral parotid gland. No bone erosion was noted. MRI investigation has shown a tumor process highly suspicious of malignancy centered on the left EAC involving the superficial lobe of the homolateral parotid gland. Adenoid cystic carcinoma (ACC) of the parotid gland was the final diagnosis, after surgical biopsy and histopathological examination. The Pre-operative check-up demonstrated multiple round shape lung lesions suggestive of multiple metastases. Considering the metastatic stage of the tumor, a collegial decision to adopt a palliative treatment approach based on chemotherapy was taken by the multidisciplinary oncology board.

Cerebral venous thrombosis during relapse of ulcerative colitis: Case report with review of literature

Cerebral venous thrombosis (CVT) is a rare but serious complication of ulcerative colitis (UC) with a high morbidity and mortality rate. CVT is not usually readily recognized and treatment may be delayed, impacting on the prognosis. Here we are reporting 2 cases of CVT occurring during a relapse of ulcerative colitis (UC) with review of literature. The first patient was a 27-year-old woman with chronic UC who presented with headaches during a relapse of chronic UC. She was found to have cerebral venous sinus thrombosis. The second one was a 45-year-old man who presented with seizures and focal neurological symptom during a relapse of chronic UC. He was found to have cerebral venous sinus thrombosis complicated by left temporal infarction. Both of them were treated with therapeutic anticoagulation with good improvement. The presence of neurological signs in a patient with UC mostly during exacerbation period, should alert health professionals about the possibility of a CVT.

Towards a large-scale integration of renewable energies in Morocco

Renewable energies are a sustainable, unlimited and decarbonised solution to address future energy challenges. In this context, Morocco has a considerable advantage to position itself on this promising market. Furthermore, renewable energies have been highlighted as a key strategic source for the country's green growth. Morocco has adopted the renewable energy path through a strategy targeted on the development of solar, wind and hydroelectric power to boost its energy policy by adapting it to the challenges posed by today's world. Nowadays, Morocco is facing a challenge to reach 52% by 2030 of its total renewable energy capacity, which will exceed 42% by the end of 2020. The main objective of this paper is to study a scenario for 2030 for the Moroccan electricity system and to identify the challenges that need to be addressed in order to accelerate the integration of renewable energies in the Moroccan energy mix and to achieve a possible export of such green energy towards Europe.

Acute abdomen in adult revealing unusual complicated epiploic appendagitis: A case report

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Think about the epiploic appendagitis more frequently when dealing with an obese patient with predispositions.

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Understand the importance of imagery that avoids unnecessary surgery in case of uncomplicated epiploic appendagitis and make it possible to do a radiological drainage.

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Always make the necessary differential diagnoses before evoking appendagitis.

Introduction

Epiploic appendagitis is a torsion of fatty appendages of ligamentum trees (1), it’s a rare cause of abdominal pain that usually manifests by right or left iliac fossa pain, reminding of appendicitis, diverticulitis or ischemia of the omentum.

Case presentation

We report the case of a 56 years old male patient admitted for an epigastric pain and a right-upper quadrant abdominal pain, for whom he underwent an abdominal ultrasound and a CT-scan who shown an abscessed mass under colic transverse to the unusual seat.

Discussion

CT scan is still the key modality for diagnosis, avoiding unnecessary surgery. Complications of primary epiploic appendagitis have rarely been described in the literature (Hwang et al., 2013; Hasbahceci et al., 2012). Another more rare complication is appendagitis with associated abscess, in this condition, we must also think about complicated diverticulitis.

The treatment of uncomplicated forms is generally conservative, however, some authors have suggested a surgical method (Saad et al., 2014).

For therapeutic management of its complication, there has been much interest in the use of minimally invasive techniques such as percutaneous drainage to minimize the morbidity and mortality that is associated with surgery (Evidence National Guideline Centre (UK), 2019).

Conclusion

The diagnosis of epiploic appendagitis is still uncommon, CT scan can eliminate other diagnosis of acute abdominal pain such as diverticulitis and appendicitis. It also allows the diagnosis of the rare complicated forms such as abscesses associated with epiploic appendagitis.

The treatment of typical forms is usually conservative, while the complicated form requires surgery because of the potential associated pathology.

[Embolization of a false arterial aneurysm in a patient living with one kidney: about a rare complication of percutaneous nephrolithotomy]

La néphrolithotomie percutanée s’accompagne d’un risque de complications en particulier hémorragiques, qui en fait une technique potentiellement invasive. Nous rapportons le cas d’une patiente de 70 ans, traitée auparavant pour néphrolithotomie percutanée d’une lithiase sur un rein unique gauche. Une hématurie persistante de moyenne abondance est apparue il y a 2 mois et demi, et qui a motivé à la réalisation d’une tomodensitométrie découvrant un faux anévrisme intra rénal polaire inférieur, d’origine iatrogène. Il a nécessité une embolisation sélective efficace à la colle biologique.

[Aorto-cava fistula complicating abdominal aorta aneurysm]

We report here a case of aorto-cava fistula complicating the rupture of a sub-renal aortic aneurysm into the inferior vena cava, which is a rare complication of aortic abdominal aneurysms with often-fatal outcome. Abdominal computed tomography with multi-planar reconstructions remains the firstline-imaging tool allowing positive diagnosis and preoperative planning. Treatment may be surgical or endovascular.

[Detection of complete common mesentery on CT scan for perforation in acute appendicitis]

Le mésentère commun complet est une anomalie rare de rotation du tube digestif. Sa découverte est exceptionnelle à âgé adulte; à cette période, il demeure très souvent asymptomatique et donc non diagnostiquée. Le mésentère commun complet peut être découvert de façon fortuite, lors d’un syndrome appendiculaire ectopique, comme ce fut le cas de notre observation. Il s’agissait d’un patient âgé de 42 ans, qui à présenté un tableau inflammatoire clinico-biologique aiguë pelvien. La TDM a permis de poser le diagnostic d’une appendicite aigue sur un mésentère commun complet. Le traitement par laparotomie a confirmé le diagnostic d’une appendicite aiguë perforée sur la malrotation intestinale. Les suites post appendicectomies étaient favorables.

Assessment of hemodialysis impact by Polysulfone membrane on brain plasticity using BOLD-fMRI

PURPOSE

Hemodialysis (HD) is considered the most common alternative for overcoming renal failure. Studies have shown the involvement of HD membrane in the genesis of oxidative stress (OS) which has a direct impact on the brain tissue and is expected to be involved in brain plasticity and also reorganization of brain function control. The goal of this paper was to demonstrate the sensitivity of the blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) to characterize the OS before and after the HD session.

PATIENTS, MATERIALS AND METHODS

Twelve male patient-volunteers following chronic HD for more than 6months were recruited among 86 HD-patients. All patients underwent identical assessment immediately before and after the full HD-session. This consisted of full biological assessment, including malondialdehyde (MDA) and total antioxidant activity (TAOA); and brain BOLD-fMRI using the motor paradigm in block-design.

RESULTS

Functional BOLD-fMRI maps of motor area M1 were obtained from the HD patient before and after the hemodialysis session, important decrease in the intensity of brain activation of the motor area after HD, and important increase of the size of the volume of brain activation were observed, these changes are reflecting brain plasticity that is well correlated to OS levels. Individual patients MDA and TAOA before and after the hemodialysis sessions demonstrated a clear and systematic increase of the OS after HD (P-value=0.03). Correlation of BOLD-fMRI maximal signal intensity and volume of activated cortical brain area behaviors to MDA and total TAOA were close to 1.

CONCLUSION

OS is systematically increased in HD-patients after the HD-process. Indeed, the BOLD-fMRI shows a remarkable sensitivity to brain plasticity studied cortical areas. Our results confirm the superiority of the BOLD-fMRI quantities compared to the biological method used for assessing the OS while not being specific, and reflect the increase in OS generated by the HD. BOLD-fMRI is expected to be a suitable tool for evaluating the plasticity process evolution in hemodialysis brain patients.

MRI findings in spinal cord penetrating injury: three case reports

Stab wounds of the spinal canal are rare and constitute an uncommon cause of spinal cord injury. They are usually responsible for an immediate neurological deficit that requires emergency therapeutic management to minimize the extent of neurological deficit and to prevent further loss of neurological function. Magnetic resonance imaging (MRI) is used to evaluate damage to the spinal cord, including contusions, hematoma and compression of extramedullary origin. We report the MRI findings in three patients admitted for spinal canal penetrating injury with neurological symptoms.

Apport de l'imagerie neurologique chez les éclamptiques encore symptomatiques après 24 heures : étude descriptive à propos de 19 cas

OBJECTIVE

To describe the neuroimaging findings in eclamptic patients still symptomatic after 24 hours.

PATIENTS AND METHODS

All parturients consecutively admitted over a 12-month period for eclampsia and presenting with neurological disorders (coma, focal neurological abnormalities, and eye sight disturbance) underwent cerebral CT-scan and/or MRI.

RESULTS

Nineteen women were studied, and all had abnormal neuroradiological findings. The CT-scan was normal in three cases. Cerebral oedema was the predominant lesion (14 cases). It was localized in the parietal or occipital area (12 cases), paraventricular area (1 case), or was diffuse (1 case). Diffusion weighted MRI was performed in four cases and showed cytotoxic cerebral oedema in one case. There were three cases of cerebral venous thrombosis and two cases of intracerebral haemorrhage.

CONCLUSION

Various neuroradiological lesions can be observed in eclamptic patients. A localized cerebral oedema is the most frequent. Diffusion weighted MRI should be systematically done when neurological disorders persist.

[Milk of calcium in a renal cyst: a case report]

Milk of calcium in a renal cyst is a rare condition. The authors report a case evaluated by ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). A 58 year - old women presented with diffuse abdominal pain. Ultrasonography showed a left upper pole cystic lesion with echogenic component in the dependent portion causing shadowing. CT showed a cyst with layering milk of calcium. On MRI, the milk of calcium sediment had low signal intensity on T1 and T2 weighted images.