Highlights The spinal subdural hematoma is a rare situation which should be evoked in any patient treated by vitamin K antagonists with signs of spinal cord compression. Magnetic resonance imaging is the imaging exam of choice to establish the diagnosis. Rapid correction of bleeding disorders is required. Sometimes, emergent surgical evacuation of the hematoma is the only therapeutic option to ensure optimal neurological prognosis. The procedures for resuming anticoagulation should be subject to a multidisciplinary consultation.
Spinal injuries represent a diagnostic and therapeutic emergency that interest especially the young and active population, they present a great risk of instability and neurological disorders involving the vital and functional prognosis, we present a case of a patient aged 30 years, admitted to the emergency room for trauma of the dorsolumbar spine, the CT scan of the spine objective an unusual displacement of a sharp fragment of the vertebral body L1 putting at risk the abdominal aorta under renal.
L'encéphalopathie pancréatique, est une complication rare de la pancréatite aiguë, notre étude porte sur 02 cas d'encéphalopathie pancréatique, hospitalisés et traités au sein du service de Réanimation chirurgicale de l'Hôpital Militaire d'Instruction Mohamed V de Rabat. L'âge des patients était compris entre 43 ans et 54 ans, nos 02 cas sont repartis en une femme et un homme. Le mécanisme physiopathologique de l'EP n'est pas encore bien élucidé, de nombreuses hypothèses ont été rapportées dans la littérature, certains auteurs suggèrent que la lipase et la Phospholipase A2 jouent un rôle dans le processus pathologique de l'EP. D'autres facteurs tels que les infections, les troubles hydroélectrolytiques, l'hypoxémie et la perturbation de la glycémie, peuvent être déclencheurs. Le diagnostic de l'encéphalopathie pancréatique est facile à établir, la symptomatologie clinique se résume le plus souvent à une confusion, avec stupeur, et agitation psychomotrice, Il s'y ajoute parfois des atteintes neurologiques comme des convulsions, une céphalée, des hémiparésies passagères, une dysarthrie, enfin des difficultés d'expression verbale et une amnésie. Les examens paracliniques, notamment L'IRM cérébrale et l'électroencéphalogramme, permettent de confirmer le diagnostic. Le traitement est d'abord symptomatique, il a comme objectif de lutter contre les facteurs qui favorisent l'apparition des signes neurologiques par les mesures de réanimation que réclame la gravité de la situation. L'évolution de l'EP est le plus souvent favorable, avec une disparition progressive des symptômes, cependant la persistance de quelques séquelles, est décrite dans la littérature. Le pronostic est fonction de la gravité de la pancréatite aigüe et des complications associées. Dans notre étude les données sont globalement comparables à celles publiées actuellement par la majorité des auteurs.
Intraoperative hypotension should be differentiated with respect to the different underlying causal mechanisms. Post-induction hypotension is defined as arterial hypotension occurring during the first 20 minutes after induction of anaesthesia and early intraoperative hypotension is arterial hypotension during the first 30 minutes of surgery. The aim of our study is to evaluate the incidence of intraoperative hypotension during surgery under general anaesthesia in a patient population and the factors influencing its occurrence. Materials and Methods: This is a prospective study, carried out over a period of 4 months on 154 patients scheduled for surgery under general anaesthesia at the Military Hospital of Instruction Mohammed V in Rabat. We collected the following information : age, sex, ASA score, body mass index, comorbidities, drug intake and type of surgery. The occurrence or not of post induction hypotension and early intraoperative hypotension. Results: The mean age of the patients in our case series was 58.5 ± 12 years. The sex ratio was 1.4 with a predominance of males. ASA I and II status were predominant. In univariate analysis: advanced age, the existence of chronic arterial hypertension and the decrease in systolic blood pressure before induction were factors favouring the occurrence of intraoperative hypotension. In multivariate analysis: We found that these 3 factors were independently related to the occurrence of intraoperative hypotension. Conclusion: We found that lower pre-induction systolic blood pressure, older age and comorbidity such as hypertension are factors independently associated with post-induction and early intraoperative hypotension. We believe that this will allow preventive optimisation of the risk through early implementation of continuous haemodynamic monitoring and adequate therapeutic intervention.
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