[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.

Tumeur maxillaire révélant une hyperparathyroïdie primitive : à propos d’un cas

Brown tumors are classic bony lesions of hyperparathyroidism. They usually occur in severe forms with osteolytic subperiosteal lesions. Facial bones are a rare localization: 2% of all cases. The aim of this study was to report a case of multiple craniofacial location of brown tumors and to discuss, within a review of the literature, the role of imagery in the diagnosis of this disease.

[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.

Thoracic epidural hemangiopericytoma. Case report

Hemangiopericytoma is an uncommon mesenchymal neoplasm that rarely affects the spinal canal. We report a case of thoracic epidural hemangiopericytoma in a 39-year-old man with symptoms of spinal cord compression studied by myelo-computed tomography (CT) and magnetic resonance imaging (MRI). Total resection was followed by complete recovery. Postoperative radiotherapy was performed. The clinical, radiological, and histological findings of epidural spinal hemangiopericytoma are reviewed in the light of relevant literature

[Tuberculous osteitis of the posterior vertebral arch: case report]

The authors report an unusual case of spinal tuberculosis involving the posterior arch of T12 without disk lesion in a 20-year-old woman presenting with posterior compression of the spinal cord. The diagnosis was suggested at CT and MR imaging and confirmed by histological study after surgical resection. CT provides good evaluation of the bony lesion and may suggest intraspinal extension. MRI is superior for evaluation of cord compression. The patient improved after surgical and medical treatment. The imaging features of this entity are reviewed.

[Isolated dorsal extradural hydatid cyst. A case report]

We report a rare case of spinal cord compression caused by a primary extradural hydatid cyst revealed at MRI.

[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.

[Dermoid cyst of the conus medullaris revealed by chronic urinary retention. Contribution of imaging]

We report a case of congenital dermoid cyst of the conus medullaris without associated dysraphic lesion treated surgically. An 18-year-old man had a one-year history of bladder sphincter disorders and more recent acute renal failure with urinary tract infection. The diagnosis of intramedullary tumor was provided by myelo CT and MRI confirmed by histology. At 10-month follow-up, the postoperative course was good.

[Contribution of spiral CT scan and MRI in spinal tuberculosis]

Spinal tuberculosis is the most frequent skeletal involvement in tuberculosis. The purpose of this study was to demonstrate the importance of the MRI and the helicoidal CT scan in the diagnosis of spinal tuberculosis. A retrospective study was conducted in 23 patients with spinal tuberculosis. The methods of investigation were helicoidal CT scan in 15 patients and MRI in the other eight patients. In the all cases with helicoidal CT scan, the features of the spinal tuberculosis were seen as an anterior vertebral body destruction with a paraspinal or epidural extension in 12 cases and a sequestrum formation in 5 cases. The analysis with helicoidal CT scan showed a gibbous deformity in 5 cases, a disk space narrowing in 14 cases and evaluated the extension very well. The MR imaging features showed one case in an early stage without features on the plain radiographs, and detected 3 cases of intramedullary lesions. A disruption of the longitudinal posterior vertebral ligament was found in one case and skip lesions at the granulomatous stage in 2 cases. MRI is superior to CT scan even helicoidal CT at the early lesion stage, skip lesions and the ligamentous or medullary lesions. For other lesions (bone, disk, extension), the MRI and CT scan are the same with an advantage for CT scan in osseous lesions.

[Vertebral body exocytosis and spinal cord compression]

Osteochondroma is a cartilaginous tumor, the most common benign tumor of bone. It may involve solitary or multiple exostoses (or osteochondromatosis) usually in hereditary multiple exostosis. The authors report a case of 13-year-old girl with a family history of hereditary multiples exostoses who presented with bilateral sciatica and cauda equina compression. The MRI showed a tumor of the L1 vertebral body. After surgery, pathologic specimens revealed the lesion to be an osteochondroma. Involvement of the vertebral column has been estimated from 1.3 to 4%. Spinal cord compression is rare. CT provides the analysis of the components of the tumor and clearly demonstrates it's intracanalar extension. MRI is superior in visualizing spinal cord compression. The prognosis is favorable after a surgical decompression.

[Spontaneous rupture of an intracerebral dermoid cyst]

Dermoid and epidermoid cysts are rare benign tumors arising from ectopic epiblastic inclusions. Dermoid cyst accounts for 0.4 to 1.5% of all tumors. We report the case of a 43-year-old man, who presented with a 6-month history of disturbances of balance and behavioral disorders. X-ray showed two fat-fluid levels in the ventricles. CT scan showed a left frontal mass with fat density, communicating with the left frontal horn. Histological examination after surgical excision confirmed the diagnosis of dermoid cyst. The diagnosis of ruptured intracranial dermoid cyst is based on the finding of an intraventricular and/or subarachnoid space fat-fluid level. MRI and CT scan facilitates the diagnosis of ruptured intracranial dermoid.

[Primary osteosarcoma of the skull. Apropos of 2 cases]

Primary tumors of the skull are rare and are estimated approximately in about 2.4% of all bone primary tumors. Primary craniofacial osteosarcoma accounts for 2 to 9% of cases in published series. The pure cranial location are estimated in the range of 0.7 to 3%. Spreading lesions to the central nervous system is uncommon, in addition plain film features are misleading due to the lock of evidence of osseous involvement of the calvaria. CT scan is more sensitive to demonstrate bone lesion as well as brain extension. MRI depict the soft tissue components even more clearly. We report two cases of skull osteosarcoma in two female patients without any preexistent affection. The particularity of these observations is that the intracranial extension presented as the brain tumor.

[Cerebral vascular accidents due to hydatid embolisms. Apropos of 2 cases]

Hydatid cysts of the brain are very rare. Exceptionally, signs and symptoms are primarily those of acute cerebral ischaemia. Two cases of acute cerebral ischaemia are reported in a 21 year old and 40 year old women. A computed tomographic scan revealed a middle cerebral artery (MCA) infarct and an abrupt cutoff of the MCA at cerebral angiography. A few months later, a CT scan showed cysts in the territory of the infarct. Hydatid cysts were also found in multiple viscera, particularly in the heart. These two observations and some cases reported in the literature suggested that the myocardial cyst may have ruptured into the ventricular cavity, resulting in widespread intravascular dissemination of embryo and causing an acute cerebral infarction. The interest of these cases lies in the rarity of an acute cerebral ischaemia due to hydatid cyst embolism, and in the early diagnosis of cardiac cysts in young patients.

[A new treatment of osteoid osteoma: percutaneous sclerosis with ethanol under scanner guidance]

Osteoïd osteoma is a benign bone tumor, easy to diagnose because of its typical presentation. However, it may be difficult in some cases: peculiar locations (spine, femoral neck...), or lack of visibility during surgery. Numerous removal technics under CT guidance have been proposed during the last few years. We will suggest another therapeutic way to treat a case of osteoïd osteoma, located in the upper extremity of the femur. The complete removal of the nidus was not possible despite two surgical attempts. So, its percutaneous sclerosis under CT guidance was accomplished, allowing the disappearance of the pain without patient immobilization afterwards. We will compare this easy and reliable method to those already described in the literature.

[Spinal aneurysmal cyst]

The authors report one case of aneurysmal rachidian cyst who concern a young girl of eleven years old presenting lumbagos with pyramidal irritation on a L2 and L3 lesion. The radiological exploration (CT, MRI) has a double interest: to find again lytical pictures of the rear arch blowing the cortical, liquids levels, logets which remind the macroscopical appearance of the aneurysmal rachidian cyst; to specify the regional extension of preoperative interest. The histological confirmation of the aneurysmal rachidian cyst after a surgical treatment and the conformity of anatomo-radiological descriptions, confirm the predictive value of the semeiology described in case of aneurysmal rachidian cyst.

[Endovascular treatment of peripheral arteriovenous malformations]

The progress made by noninvasive exploration for the assessment of vascular malformations now allows the therapeutic strategies to be better established. While observation and conservative methods are most often chosen, some arteriovenous malformations lead to contemplating a palliative or curative treatment. In these cases, embolization currently plays a great role, associated or not to surgery. This embolization obviously can be contemplated only after a collegial decision to treat these malformations has been made, knowing that they may be silent or acquire an uncontrollable evolution potential. The authors present 3 cases of peripheral arteriovenous malformations, treated by an endovascular way, and remind the principles and indications of these embolizations.

[Contribution of radiology to the diagnosis and treatment of nasopharyngeal fibroma. Apropos of 6 cases]

The authors report about their experience with 6 cases of nasopharyngeal fibroma. They emphasize the interest of CT examinations in the diagnostic study, and above all in the assessment of regional extension. The angiographic study must be as complete as possible, and should include an embolization within 2 to 5 days prior to surgical excision as often as this is possible. Embolization is a simple procedure if performed strictly and carefully in order to avoid any complication.

[Cerebromeningeal tuberculosis. X-ray computed tomographic aspects apropos of 36 cases]

Thirty-six patients with different clinical and topographic forms of cerebromeningeal tuberculosis: meningitis, meningo-encephalitis, tuberculoma, abscess and their complications, were investigated by CT scans. Whereas standard films allow diagnosis of intracranial hypertension, other neurological examinations are very insufficient when compared with CT imaging, a non-invasive procedure which provides presumptive signs of a tuberculous lesion and thus assists diagnosis, and assessment and follow up of results of treatment. Meningitis and meningo-encephalitis are seen as isodense images of cisternae of base of skull with marked increase after contrast, which may provoke the appearance of hyperdense nodules. More or less widespread hypodensities are provoked by meningoencephalitis, cerebral tuberculosis appearing as an iso- or hyperdense mass forming an annular shape after contrast. Calcification is a rare finding and appears as punctiform zones in the center of a tuberculoma, while a tuberculous abscess has the identical appearance to that of a nodular tuberculoma.

[Vertebral and spinal cord hydatidosis. Contribution of radiology and x-ray computed tomography. Apropos of 36 cases]

A study of 36 cases of vertebral and spinal cord hydatidosis seen between 1970 and 1984 allowed their division into three groups: those with purely intravertebral lesions, vertebral hydatid osteopathy, and hydatid pseudo-Pott's affections. The contribution of conventional radiology is reviewed at length and the importance of computed tomography emphasized for screening of extension and surveillance of "white cancer", a term applied by Deve to bone hydatidosis. Use of the scanner for CT imaging makes screening for residual or recurrent lesions a radiologic exploration.