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Les manifestations neurologiques de la syphilis sont polymorphes et sont actuellement en recrudescence. Nous rapportons cinq cas d´accident vasculaire cérébral ischémique (AVCI) en rapport avec une neurosyphilis. La recherche d´une syphilis doit être systématique devant un accident vasculaire du sujet jeune d´étiologie indéterminée.

Radiation therapy has been one of the pillars of cancer therapy for many years. Many technological advances have been made to improve radiation delivery to the targeted area while reducing damage to the surrounding normal tissue. The spectrum of late radiation-induced injuries is quite heterogeneous but the injuries are usually benign. They may manifest themselves as breast edema, fibrosis, telangiectasia, pulmonary fibrosis, chronic ulceration, rib fractures, fat necrosis or osteonecrosis. We report the case of a 55-year-old woman who presented to the Neurosurgery Department for management of hydrocephalus with a posterior fossa tumor. The patient had a past history of a multifocal adenocarcinoma of the both breast, which were resected 13 years earlier. Further treatment included chemotherapy with six cycles of doxorubicin and cyclophosphamide in combination with cobalt radiation with a total dose of 60 Gy, followed by tamoxifen for a total of 4 years. The first local signs were observed two years after the radiation treatment with the loss of irradiated skin elasticity followed by increasing induration and telangiectasia. Over the one year before presentation, the mass had significantly increased in size and become increasingly painful, restricting the patient psychologically and functionally in her daily activities. Local examination revealed a subcutaneous fat necrosis of the right breast, which had been progressively growing over a period of 02 years (A).

Nous rapportons une observation originale d´un syndrome de Korsakoff révélant une lésion thalamique, chez un patient de 44 ans, ayant bénéficié d´une biopsie stéréotaxique dont l´étude anatomopathologique montrait un tuberculome cérébral. A notre connaissance une telle présentation jamais décrite dans la littérature francophone, nous semble importante d´alerter le clinicien Afin de l´explorer, par une imagerie cérébrale toute l'amnésie korsakovienne atypique.

A 56-year-old diabetic man complains for isolated chronic headaches for many years. He denied any seizure, involuntary limb movements or blurring of vision. Physical examination was unremarkable for any focal neurological deficits. Cranial Computed tomography (CT) scan showed extensive symmetrical calcifications of the bilateral basal ganglia and over the lateral periventricular areas (figure). Laboratory studies including serum calcium, phosphate, parathormone, thyroid hormones and vitamins were within normal range. There was no other obvious etiology or family history of similar illness. Based on these findings, the patient was diagnosed with Fahr´s disease and was managed conservatively. Fahr´s disease (FAD), also known as “familial idiopathic basal ganglia calcification”, is a rare neurological disorder characterized by abnormal calcified deposits in the basal ganglia, cerebellum and subcortical white matter. FAD differs from Fahr´s syndrome in which there is an underlying cause for brain calcifications. Neurological and psychiatric symptoms are variable and may include deterioration of motor function, parkinsonism, seizures, headache, dysarthria, spasticity, visual disturbances, dementia, psychosis, and affective disorders. FAD could be easily confused with other more common neurological and psychiatric disorders. It is particularly important to not miss the treatable etiologies of Fahr´s syndrome. The diagnosis is based on the CT scan because it is difficult to identify calcifications by routine magnetic resonance imaging. Treatment is essentially symptomatic.

Detection of metastases especially intracranial metastases signals a poor prognosis in a patient with cancer. Solitary cystic metastasis is often difficult to differentiate from intra-cerebral abscess which can also occur in these patients. However, the co-existence of an abscess within a CNS metastasis is a rare event. At surgery, a purulent exudate within discrete metastatic tumours was identified. Pathological and microbiological examinations confirmed the coexistence of an abscess within a metastatic carcinoma. This case highlights the importance of considering intratumoral abscesses.

A 45-year-old obese man, previously healthy, presented with a 7-month history of neurogenic claudication of both legs and bilateral sciatic radiculopathy without bowel or bladder disturbances. He had a body mass index of 34.6Kg/m2 but neurological examination was normal. Spinal magnetic resonance imaging (MRI) showed an extensive lumbosacral spinal epidural lipomatosis (SEL) rounding and compressing the thecal sac and nerve roots (A-C). There was no other obvious etiology. After 5 months of follow-up, symptoms resolved by weight loss. Spinal epidural lipomatosis is the result of accumulation of unencapsulated fat tissue in the extradural space of the spinal canal. This unusual disease may impinge on the thecal sac in the lombosacral area and cause spinal cord compression in the cervicothoracic area. Epidural lipomatosis is usually associated with corticosteroid therapy, but a number of etiologies have been reported in patients with Cushing´s syndrome, hypothyroidism, and pituitary prolactinoma. In idiopathic SEL, no obvious etiology was associated. Conservative treatment such as weight reduction may relieve neurologic symptoms in obese patients with idiopathic spinal epidural lipomatosis. However, in the presence of neurological impairment, extradural surgical decompression must be performed.

A 50-year-old woman, previously healthy, presented with a 9-month history of progressive paraparesis with sphincter disturbances and hypoesthesia in lower legs. Several weeks before admission, her paraplegia and urinary dysfunction rapidly deteriorated. She was unsuccessfully treated 4 months prior with analgesics and corticosteroids drugs. Spinal magnetic resonance imaging (MRI) (A) showed central myelopathy of the conus medullaris with posterior dilated perimedullary veins (arrows), suggestive of a spinal vascular malformation. Selective spinal angiogram of the right T11 segmental artery (B) demonstrated a right sided fistulous connection between the segmental artery and the perimedullary venous plexus (dotted oval circle). A thoracic T10-T12 laminectomy and durotomy was performed, which showed engorged venous vessels on the posterior surface of the spinal cord (C). An arterialized draining vein was identified arising from the inner aspect of the dura of the right T11 nerve root. This vessel was completely clipped (arrow). Postoperatively, neurologic examination remained unchanged at the time of discharge. However, at 4-month follow-up, she was able to ambulate with a walker. Postoperative angiography performed 2 months later showed total disappearance of the vascular fistula (D). Spinal dural arteriovenous fistula (SDAVF) is a rare cause of progressive myelopathy. This vascular malformation is usually misdiagnosed because its clinical features can mimic more common causes of myelopathy (Neoplams, infections, musculoskeletal, inflammatory and nutritional). Also, MRI may be interpreted as normal for a relatively long period of time. High clinical suspicion for SDAVF when MRI is uncertain should prompt spinal angiography to avoid delay in this treatable disease.

A 75-year-old hypertensive woman presented with 2-day history of right sided weakness and speech disturbances. Neurologic examination revealed right hemiparesis, anosmia and dysfunction of the left third and sixth cranial nerves. Brain computed tomography scan (A,B) followed by magnetic resonance angiography (C,D) discovered an unruptured cavernous carotid aneurysm measuring 40 x 39 mm in diameter (stars) on the left side with a concomitant acute ipsilateral frontal infarction (arrows). The giant calcified saccular aneurysm contained a dense, structured, and intraluminal thrombus. Laboratory studies were within normal range. Based on these findings, the patient was diagnosed with a thrombosed unruptured carotid-cavernous aneurysm with homolateral anterior cerebral artery ischemic stroke. Exploration of the supra-aortic arteries was normal. No other sources of brain infarction were found on electrocardiogram, transthoracic echocardiography and Holter monitoring. The patient was referred to interventional neuroradiology for endovascular coiling of the aneurysm. Intracranial aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery results in an abnormal widening or ballooning. Rupture of the aneurysm is the most common and most serious complications seen in this disease. The resultant subarachnoid and/or intraparenchymal bleeding can lead to a hemorrhagic stroke, coma and/or death. Cerebral infarction is a rare complication especially seen in unruptured intracranial aneurysms. Possible pathogenic mechanisms of the infarction include parent artery occlusion due to local extension of the luminal thrombus, distal embolization, and increased mass effect. Unruptured aneurysm should be added to the list of etiologies of ischemic strokes.

This 48-year-old man, previously healthy, presented with a six-month history of progressive low back pain and bilateral pseudo-sciatica of the lower extremities without sphincter disturbances. Physical examination revealed fixed kyphotic posture of the lumbar spine. Straight leg test and tendon reflexes were normal without any neurologic deficits. He reported sustaining a traumatic injury two years earlier secondary to a fall from a tree. At that time, he did not seek medical treatment. Plain radiograph (A) demonstrated regional lumbar kyphosis from L1 to L3 as well as a healed burst fracture of L2 vertebra (star). Spinal lumbar computed tomography scan (B-C) confirmed traumatic kyphotic deformity at L1-L2-L3 and moderate central stenosis at L2. There was also a new joint surface formation and vacuum phenomenon between the anterior vertebral bodies of L1 and L3. The patient was counseled on the need for surgery, but he refused any surgical intervention and insisted on conservative management. Neglected lumbar spinal injuries are rare but serious clinical situations. Their etiologies vary from missed injuries, delayed presentation for treatment, and wrong initial management. The clinical symptoms include spinal and/or radicular pain, scoliotic and/or kyphotic deformity, and neurological deficits. Management of these neglected injuries is difficult with respect to intraoperative difficulties, higher incidence of surgical complications, and subsequent rehabilitation.

A 12-year-old girl was involved in a 50 km/h motor vehicle accident that resulted in the deployment of both airbags. She was a front seat passenger well restrained by a three-point seatbelt. The driver (his father) was uninjured but the patient complained of a stiff and painful neck. On arrival in the emergency room, she was alert and hemodynamically stable. Physical examination showed swelling and excoriation of the skin over the anterior cervical area and mandibular region (A). Neurological examination results were normal except for torticollis and neck pain. Cervical spine radiography showed no abnormality except the loss of cervical lordosis. She was admitted for observation and was discharged ten hours later with a cervical collar and symptomatic drugs. At 15-day follow-up visit, the patient had no neck pain, and the neurological examination finding was normal. Airbags drastically reduce both morbidity and mortality from crashes, but a wide range of injuries has been reported as a result of direct contact of hot gas with facial skin and energy transmitted directly from the airbag system to the child´s head and neck. This device may cause ocular and facial injuries, abdomen and chest trauma, upper extremity injuries, and cervical spine lesions especially in pediatric populations. All children below 12 years of age or less than 40 kg of weight must not occupy the front seat passenger. Airbags may induce injuries that vary from minor to fatalities whatever the impact velocities. Practitioners should be aware about lesions induced by airbag deployment.

Brown-Séquard´s syndrome (BSS) is an unusual clinical entity caused by damage to one half of the spinal cord mimicking a classic hemiplegia. This syndrome is characterized by ipslateral loss of motor function (paralysis), proprioception, and vibratory sensation, combined with contralateral loss of pain and temperature sensation. Spinal cord injuries and tumoral diseases were the most frequent etiologies associated with BSS. Spontaneous cervical disc herniation has rarely been considered. This 49-year-old man, previously healthy, presented with a two-year history of progressive left arm and leg paresis associated with decreased pain and thermal sensitivity in the right hemibody below the C5 dermatoma without bladder or bowel complaints. There were bilateral extensor plantar responses. Brain computed tomography (CT) scan performed at another institution was normal. Spinal cervical magnetic resonance imaging and CT-scan showed a voluminous calcified cervical disc herniation at C4-C5 vertebral level (arrows) with marked compression of the left half of spinal cord. A complete surgical spinal cord decompression was performed by an anterior cervical approach with interbody fusion. There was a partial recovery of neurological status after a long time of physical rehabilitation. In some incomplete forms of BSS, hemiplegia or hemiparesis may be confused with those caused by brain damage as seen in our patient. Accordingly, the diagnosis is further delayed. Spinal MRI should be employed early in the diagnostic evaluation of such patients. In addition, cervical disc herniation should be considered in the differential diagnosis of BSS, even in the absence of the typical symptoms.

Intervertebral disc calcification (IVDC) is a rare cause of spinal pain. Both children and adults can be involved, however this affection is more common in cervical and thoracic spine than lumbar column. A 52-year-old man, previously healthy, presented with an acute lumbalgia. He complained of spontaneous low back pain for more than 4 months, aggravated for the last few weeks. He denied any history of injury, important change in weight, systemic disease or recent episodes of fever. Physical examination revealed limitation in low back movements with paraspinal muscle spasm. Straight leg test and tendon reflexes were normal without any neurologic deficits. Computed tomography scan (A, B, C) showed an unusual homogenous, well limited, calcified lesion at the L4-L5 intervertebral level (arrows) with a straightness of the lumbar spine. The calcified structure rather corresponds to the nucleus pulposus: the central portion of intervertebral disc. Laboratory finding showed no inflammatory sign. The patient was treated with rest, analgesic and anti-inflammatory agents. Symptoms resolved few weeks later. The etiology of IVDC still remains uncertain and in most adult patients, this phenomenon is known as an idiopathic rare condition. The majority of cases are pauci or asymptomatic. Calcification in children is usually spontaneously resolved, unlike in adults in whom calcified deposits in discs are rather permanent. As seen in our patient, most symptomatic cases are treated conservatively with an excellent prognosis. Rarely, the calcified discs may occasionally lead to nerve root or spinal cord compression. Thus, neurosurgical decompression with excision can be planned

Isolated orbital roof fractures are raremost of these fractures heal without any complications. Traumatic optic neuropathy (TON) is one of the rare but catastrophic complications of orbital roof fractures. A 37-year-old gentleman was admitted in our emergency department following road traffic accident. He fell down from a motocycle, on presentation to the emergency department he felt a little drowsy, had vomited twice, and complained of pain around his right eye. His Glasgow Coma Scale was 15/15. Clinical examination revealed right periorbital hematoma with edematous lids closing the right eye and ecchymosis, and pupils were equal in size. Eye movements was normal but visual acuity in the right eye was 2/10 and in left 9/10. CT scan of the facial bones (slice thickness 1 mm) demonstrated a comminuted right orbital roof ´blow-in´ fracture (A,B,C,D) with associated non-displaced linear fracture extension towards the optic canal fracture. Magnetic resonance imaging MRI axial T2 flair showed a contusion of the right optic nerve (A,B,C,D). Traumatic optic neuropathy (TON) refers to optic nerve damage secondary to trauma, which occurs in approximately 0.5-5% of head injuries and 2.5% of patients with maxillofacial trauma and facial fractures. It is defined as any damage to the optic nerve secondary to trauma that may occur primarily or secondarily to the initial insult. It is crucial to make an appropriate diagnosis of orbital roof fracture if present because of its possible medical implications like enophthalmos or proptosis, facial asymmetry, visual loss, and eye movement restriction.

Osteoblastoma is an uncommon benign bone tumor. which accounts for approximately 1% of all primary bone tumors. It is commonly seen in the long tubular bones and in the vertebral column, It is rarely found in the calvarium. The tumor has a preference for frontal and temporal bones and has rarely been reported in the occipital bone. In one large study of 306 osteoblastomas, only 11 (4%) were located in the calvarium. To date, only 62 cases of calvarial osteoblastoma, have been reported in the English literature. A 34-year-old man, he had occipital neuralgia with intense pain that feels like a sharp, jabbing, electric shock in the back of the head and neck,he presented a mild tender progressive swelling in the occipital area, which had persisted for 6 months prior to the patient´s admission. The patient appeared otherwise well, and had no significant past traumas or medical history. A physical examination revealed a hard smooth mass, which was fixed to the underlying occipital bone. The skin overlying the lesion was normal and did not adhere to the mass. There were no neurological deficits. Computed tomography (CT) scanning of the brain using bone reconstruction techniques showed a midline occipital suboccipital bony lesion and extending from the torcula (A,B). During surgery, the mass was completely excised by en bloc removal, after making a burr hole in the surrounding normal bone. Postoperative management is straightforward with Immediate disappearance of occipital neuralgia. The findings of histopathological examination were consistent with the diagnosis of a benign osteoblastoma.

Les neurocytomes centraux (NC) sont des lésions bénignes qui se développent généralement à partir des noyaux du septum pellucidum et se présentent sous forme de tumeurs intraventriculaires. Le CN est généralement une tumeur bénigne classée au grade II par l'Organisation mondiale de la santé et associée principalement à une issue favorable. La présentation clinique typique du CN comprend des céphalées, des vomissements des troubles de mémoire ou de vision, des convulsions, parfois révélé par une hydrocéphalie. L´exérèse chirurgicale totale de la tumeur est considérée comme le meilleur traitement et favorise les taux de survie sans récidive. Ici, nous rapportons un cas de NC atypique.

The Dandy-Walker malformation (DWM) is a rare congenital malformation involving the posterior fossa.it was first described in 1914 by Dandy and Blackfan. It is diagnosed when the following 3 main signs are identified: agenesis or hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and an enlargement of the posterior fossa. However, the co-existence of the DWM with precocious puberty is rare. Precocious puberty is characterised by premature appearance of secondary sexual characteristics before the age of 7 years in girls and 9 years in boys. There are rare reports of the co-existence of the DWM and precocious puberty. A 6-year-old male child presented with enlargement of penis and appearance of axillary and pubic hair. His parents noticed a recent change in his voice, he was admitted to the hospital with complaints of headache for 3 months. He was free from dizziness, nausea, vomiting, or limb weakness. He had normal vision, muscular strength and muscular ton. Magnetic resonance imaging MRI axial T1, and sagittal T2 flair showed an atrophy of the cerebellar hemispheres, hypoplasia of the vermis, and an enlargement of the fourth ventricle, which communicated with the occipital cistern forming a posterior cerebellar cyst compatible with variant DWM.

Sacral bone tumors usually remain clinically silent for a long period and are often discovered in the context of nerve root compression (S1 or S2 radiculopathy or inflammatory sciatica) or pelvic organ compression. The most common sacral tumors in adults are metastases and intraosseous locations of hematological malignancies (lymphoma or multiple myeloma), while primary bone tumors and meningeal or nerve tumors are less common; Metastatic lesions of the sacrum are rare, but pose a complex problem for surgical management. The clinical pattern of presentation depends on the anatomical location of the tumour and whether it invades or compresses neighbouring structures. We report the case of a 67-year-old man who presented with a 2-year history of intermittent low back pain with sudden urinary retention. Additionally, he was under care for chronic constipation and fecal impaction. A lumbar computed tomography (CT) scan and magnetic resonance imaging shows a heterogenous mass occupying The sacrum to the coccyx with 12-10-8 cm in size (A) . A needle biopsy revealed that this lesion was an infected metastatic carcinoid (B). Sacral tumors usually have reached an advanced stage and a large size by the time that they are diagnosed, and these conditions make the resection of the tumor technically demanding and the chance of achieving a wide margin less likely. The achievement of an adequate margin often leads to pelvic instability as well as to a loss of neurological function.