Biomedical subjects

M A Rafai

Publications and source records attributed to M A Rafai.

11 recordsLinked to original sources

PubMed2006

[The presentation of viral hepatitis C infection without cryoglobulinemia with a peripheral neuropathy. Five case reports].

INTRODUCTION: Peripheral neuropathies are the most common neurological complication of viral hepatitis C infection with mixed cryoglobulinemia. CASES REPORT: We report five cases (three men, two women) of peripheral neuropathies revealing viral hepatitis C infection without cryoglobulinemia; the patients' mean age was 56 years. Paresthesias were the most frequent symptom. Electroneuromyographic examination found one case of polyneuropathy and four cases of multiplex mononeuropathies; the complement level was normal in all patients and the rheumatoid factor positive in two cases. Etiological investigations for peripheral neuropathy remained negative. Treatment and outcome were variable. DISCUSSION: Negative cryoglobulinemia in cases of VHC infection with neurological features has been described in the last few years, suggesting the possibility of other mechanisms such as direct action of the virus on the nervous system. There is no consensus on the treatment and outcome is variable. CONCLUSION: Peripheral neuropathy may reveal VHC infection, underscoring the need for VHC serology testing in etiological investigations for peripheral neuropathies.

Adrenal Cortex Hormones↗

PubMed2006

[Symptomatic periodic paralysis secondary to primary Sjogren's syndrome].

INTRODUCTION: Hypokalaemic periodic paralysis can be primitive or secondary to potassium deficiency which can arise from several causes. Primary Sjogren's syndrome is a rare cause related to kidney involvement. CASE REPORT: A 50-year-old woman has been admitted for hypotonic tetraparesis which had appeared a few days earlier. History taking revealed three previous similar episodes with a notion of oral and lacrimal dryness. Laboratory tests revealed severe hypokalaemia, hyperchloremia, alkaline urinary pH and a minima 24h proteinuria. Additional investigations led to the diagnosis of a primary Sjogren's syndrome defined on the basis of international criteria. Kidney biopsy revealed tubular-interstitial nephritis. Oral corticosteroïd therapy and potassium supplementation led to symptom improvement. A recurrent episode also responded to treatment. Additional urinary alkalinisation has prevented further relapse. DISCUSSION: Primary Sjogren's syndrome is an exocrine disease causing systemic disorders. Tubular-interstitial nephropathy may occur in 25 percent of patients leading to distal tubular acidosis defined by the association of hypokalaemia, hyperchloremia and alkaline urinary pH. When hypokalaemia is severe, periodic paralysis may occur. CONCLUSION: Primary Sjogren's syndrome can lead to nephropathy and subsequent hypokalaemic periodic paralysis. Urinary alkalinisation is essential to prevent this catastrophic presentation from recurring.

Adrenal Cortex Hormones↗

PubMed2006

[Bilateral idiopathic orbital myositis].

INTRODUCTION: Orbital myositis is an idiopathic inflammation of the extraoccular muscles. It is often included under the broad description of orbital pseudotumor. It is commonly a unilateral affection. CASE REPORT: We report one case of bilateral orbital myositis in a 45-year-old woman. The first symptoms were diplopia and acute bilateral orbital pain exacerbated by eye movements. Physical examination especially neurological was normal. Serum creatine kinase and biological thyroid function were normal. CT scan found a bilateral enlargement of rectus oculi medialis and lateralis. Clinical improvement was obtained a few days after oral corticosteroid treatment with remission of all signs. CONCLUSION: Orbital myositis is a rare entity. 90-95p.cent of cases are unilateral. Bilateral forms are exceptional and in this case require search for specific etiologies particularly thyroid ophthalmopathy. There is controversy concerning treatment options but corticosteroids are still the most common first choice therapy with good outcome.

Adult↗

PubMed2006

[Chronic inflammatory demyelinating polyradiculoneuropathy in childhood: outcomes after methylprednisolone pulse therapy].

INTRODUCTION: Chronic inflammatory demyelinating polyneuropathy (CIDP) in children is relatively rare and treatment is based primarily on intravenous immunoglobulins or oral corticosteroids. Boluses of methylprednisolone (MP) are a seldom used alternative. CASE REPORT: We report the case of an 8-year-old child, first presented at the age of 3 years, with recurring episodes of functional impotence of both lower limbs and walking impairment, partially reversible without treatment. Clinical, progressive, and electrophysiological data and the analysis of the cerebrospinal fluid were compatible with CIDP. MP boluses were administered: after a total eight monthly boluses, very satisfactory progression on the clinical and electrophysiological fronts was noted after 24 months. CONCLUSION: Childhood CIDP presents clinical, electrophysiological, progressive, and prognostic particularities, they recur readily and the outcome is good. Boluses of methylprednisolone are an alternative to the treatment of these neuropathies in childhood.

Anti-Inflammatory Agents↗

PubMed2006

[Peroneal nerve schwannoma presenting with a peroneal palsy].

Peroneal nerve injury in the lateral aspect of the knee is frequent, commonly dominated by traumatic or compressive etiologies. Tumors, generally synovial cysts, are exceptional causes. We report a case of a 70-year-old women referred for assessment of peroneal palsy syndrome found to be related to peroneal schwannoma in the lateral aspect of the knee. Schwannoma is the most frequent peripheral nerve benign tumor. It is commonly limited to cranial and upper limb nerves. Localization on the lower limbs (sciatic nerve) has been reported in 1 percent of cases. The peroneal nerve localizaton has not been reported to date. We underline difficulties of diagnosis inherent to this particular localization.

Aged↗

PubMed2006

[Reccurent stroke revealing catastrophic antiphospholipid syndrome with hepatitis C viral infection].

INTRODUCTION: Very little cases of antiphospholipid syndrome (APLS) have been described among patients having chronic hepatitis C virus infection (HCV). CASE REPORT: We report the observation of a 43-year-old woman who presented APLS diagnosed following recurrent strokes. Etiological investigations concluded on an association of APLS with HCV infection. DISCUSSION: Besides being exceptional, this association raises certain etiopathogenic problems. Indeed while antiphospholipid antibodies (aPL) are frequently noted during chronic hepatitis C, they rarely generate thromboembolic complications.

Adult↗

PubMed2005

[Systemic lupus erythematosus presenting with a choreo-athetosic syndrome associated with antiphospholipid antibodies].

INTRODUCTION: Chorea is a rare manifestation of systemic lupus erythematosus (1-4 percent), commonly affecting young woman. Chorea is revealing lupic disease in 50 percent, in the other cases it occurs early in the course of the disease. OBSERVATION: A 33-year-old woman was hospitalized for choreo-athetosic movements prevailing on the left leg and arm accompanied by behavioral and general state deterioration. The biological assessment consolidated the diagnosis of lupic disease associated antiphospholipides antibody (aPL). Cerebral magnetic resonance imaging (MRI) was normal except for cortical and subcortical atrophy. The patient was treated by corticosteroids (1mg/kg/day) and then was lost to follow-up. CONCLUSION: We review data in the literature on the pathophysiological mechanisms of lupic chorea focusing particularly on role of aPL.

Adult↗

PubMed2005

[Devic's neuromyelitis optica in Morocco. A study of 9-cases].

INTRODUCTION: Optic neuromyelitis or Devic's syndrome associates optic neuritis and myelitis. It can have a monophasic or relapsing course. The limits of this entity remain controversial. METHODS: We analyzed the results of a retrospective series of Moroccan patients with Devic's syndrome defined on the basis of Wingerchuk's criteria. RESULTS: Six women and three men were retained for study; average age was 39 years. Three patients presented with a monophasic form and six with relapsing disease. CSF analysis was abnormal in five. Brain MRI was normal in eight. Signal abnormalities extended over more than three vertebrae in eight patients. Infections were associated with neurological features in half of the patients. DISCUSSION: Our results are in agreement with those of large series in the literature regarding the clinical, imaging, and laboratory findings and disease course. We also noted that infections were more frequently associated with Devic's syndrome in our patients. CONCLUSION: Our study reports the results of the first North African series of Devic's syndrome patients. We suggest that this syndrome is particular in our context due to the high frequency and diversity of associated infections.

Adult↗

PubMed2005

[Aseptic meningoencephalitis in primary Gougerot-Sjögren's syndrome].

INTRODUCTION: Central nervous system involvement is rarely observed in primary Sjogren's syndrome (PSS) and aseptic meningoencephalitis occurs exceptionally. OBSERVATION: We report the case of a 25-year-old woman who presented with weakness of the four limbs, vision loss and concentration deficit. Neurological examination revealed a mental confusion, cerebellar involvement and spastic tetra paresis. Cerebrospinal fluid analysis revealed elevation of cell counts (162/mm3) and protein content (3 g/l). MRI showed increased T2 signals in the white matter. No evidence for an infectious etiology, especially tuberculosis, was obtained in this patient. PSS was diagnosed on the basis of ocular dryness, lachrymal hyposecretion, aspects of labial gland biopsy witch revealed destruction of the ducts with periductal lymphocytic infiltration and positive anti-SSB antibodies. Oral corticosteroids (1 mg/kg/day) allowed an improvement of the neurological manifestations. CONCLUSION: Aseptic meningoencephalitis can be the first manifestation of primary Sjogren's syndrome. Infectious causes, particularly tuberculosis which is frequent in our context must be ruled out.

Adult↗

PubMed2005

[Devic's optic neuromyelitis and pulmonary tuberculosis].

INTRODUCTION: Optic neuromyelitis or Devic's syndrome is a very rare disease affecting the optic tracts and the spinal cord. Its association with evolving pulmonary tuberculosis has been noted in a handful of case reports. CASE REPORT: The authors reportthe case of a 40 year old patient with evolving pulmonary tuberculosis who experienced bilateral blindness followed by paraplegia and sphincter disturbance. Clinical examination and investigations excluded direct tuberculous involvement of the nervous system or a reaction to antituberculous therapy and Devic's syndrome was diagnosed, based on Wingerchurk's criteria. Following treatment with corticosteroids and antituberculous chemotherapy, the patient recovered normal mobility and sphincter control but remained completely blind. CONCLUSIONS: Throughout this case report, the authors emphasise the rarity of this association and discuss the pathophysiological mechanism, which appears to be an immune dysfunction triggered by mycobacterial infection.

Adult↗

PubMed2004

[Devic's optic neuromyelitis and viral hepatitis type A. A paediatric case report].

INTRODUCTION: Devic optic neuromyelitis is a rare clinical disease that involves severe transverse myelitis and unilateral or bilateral optic neuropathy. Its pathogenesis would be explained by demyelinization triggered by bacterial or viral infections phenomena. According to several author, prognosis would be better in children. CASE REPORT: We report a case of optic neuromyelitis in an 8-year-old child with an uneventful history who was admitted because he suffered from flaccid tetraplegia and sudden decline of the visual acuity. The ophthalmologic examination revealed bilateral neuropapillitis. The medullary MRI visualized a spreading myelitis with bifocal arachnoiditis. Search for a precipitating infectious factor showed positive IgM for viral hepatitis A. With corticosteroid treatment the child achieved total recovery of vision and recovered motor and sensorial function of the upper limbs and the trunk. Paraplegia with sphincteral disorders persisted. CONCLUSION: This case characterized by the precipitating factor (hepatitis virus A), illustrates this rare syndrome. We present a general review of the pediatric cases reported in the literature.

Child↗