Nutritional deficiency after bariatric surgery has its consequence on nervous system. Thiamine reduction occurs weeks after surgery, which results in dysfunction of both central and peripheral nervous system. We report a case of a young female patient who was subjected to bariatric surgery four months ago, then she developed ascending flaccid paresis due to polyradiculoneuropathy, facial diplegia and respiratory distress; these manifestations were preceded by ataxia and disturbed conscious level. After an initial diagnosis of Miller Fisher variant of Guillain-Barré Syndrome, the patient received two sessions of plasma exchange, then we revised our diagnosis based on clinical signs and brain imaging which was suggestive of Wernicke's encephalopathy. Consequently, we started thiamine infusion which resulted in improvement of both power and cognitive functions. Upon this case, we can deduce two key points: first, the importance of good nutritional support after bariatric surgery; second, the importance of considering nutritional deficiency as a differential diagnosis when facing any case with prior history of bariatric surgery.

Background: Trigeminal neuralgia (TN) is still a serious neurologic condition that causes significant facial pain that is unilateral and is distributed across the trigeminal nerve. Magnetic resonance imaging (MRI) is an excellent imaging technique for determining the aetiology of TN, despite the fact that there are no particular clinical tests for its diagnosis. 3D FIESTA MRI helps to improve diagnostic precision and identify neurovascular compression when used in conjunction with conventional MRI. MRI is used to rule out alternative causes of TN, such as cerebellopontine angle lesions, demyelinating diseases, and inflammatory conditions, in addition to neurovascular compression. Aim of the Work: The objective of this study was to assess the utility of MRI in the diagnosis of TN and its various causes. Patients and Methods: In this prospective study, 30 patients (14 men and 16 women), with an average age of 49.6 years, were referred to Tanta University Hospital's Radiodiagnosis and Medical Imaging Department from outpatient neurosurgery and/or dental clinics. Results: The commonest affected side was the left side (46.7%) followed by the right one (40%), while bilateral affection was seen in (13.3%) of cases. According to aetiological factor, TN was secondary to underlying pathology in 24 cases (80%), while idiopathic TN with no underlying pathology was found in 6 cases (20%). Neurovascular compression and neoplastic lesions had the higher incidence. The most affected segment of the trigeminal nerve was the cisternal segment that was involved in 15 cases out of 24 cases with abnormal MRI findings. Conclusion: Many CPA lesions may cause TN such as schwannomas and meningiomas. Demyelinating disease as multiple sclerosis were reported in our study to cause also TN. MRI showed that it has significant diagnostic role denoting brain lesions in patients with TN as it has a diagnostic accuracy 62.5%, sensitivity 60% and specificity 100% (P < 0.001).

Background:-lupus nephritis occurs in up to 60-70 % of patients with SLE and also constitutes one of the major organ manifestations that considerably alters the course and prognosis of SLE. LN is considered a major cause that leads to renal failure, which has a major impact on the short and long-term outcomes of patients with SLE. Regimens containing immunosuppressive drugs are the main treatment for active LN and early treatment response can predict long-term prognosis, So we aim to find reliable predictors of early treatment response in patients with SLE. Finding more comprehensive parameters to develop a better treatment regimen may help decrease longer-term morbidity and mortality. Aim of the study: to examine the predictive factors of renal remission in lupus nephritis patients with lupus nephritis. Results: In our study, after diagnosis by six months, about 61% of patients achieved remission. We found that the Chronicity index and Presence of interstitial fibrosis, are reliable factors for predicting the treatment response either the responder or not at the end of the sixth month of treatment. On multivariate analysis, the Chronicity index was considered an independent predictor of disease remission after 6 months Conclusion: Chronicity index ≤ 3 was considered of significant value for detecting treatment response at the sixth.

Introduction: Decompression followed by enucleation of Keratocystic odontogenic tumour (KCOT) is a recommended conservative approach for large KCOT to prevent injury to the surrounding vital structures, pathological fracture of the mandible and radical resection surgery. On the other hand, this approach necessitates multiple surgi-cal procedures and prolonged follow-up which depends on the patient's compliance and may increase the risk of infection.Case report: A 42-year-old male presented with large right mandibular angle KCOT associated with impacted wis-dom tooth. Decompression, incisional biopsy, and extraction of wisdom tooth were performed under Local anaes-thesia. CBCT, 3 and 6 months post-operatively demonstrated obvious reduction of cystic cavity which allowed for enucleation of KCOT followed by Carnoy's solution application under GA with minimal complications. Conclusion:Decompression of large KCOTs followed by enucleation with peripheral ostectomy or chemical therapy is viable treatment option to avoid invasive resection surgical procedure.

BackgroundBone and joint involvement in tuberculosis is uncommon. Wile osteoarticular tuberculosis most commonly occurs in the vertebral column, less frequently affected sites are the hip, knee and sacroiliac joints. The multifocal form of skeletal tuberculosis is exceptional.ObjectivesTo evaluate the clinical and diagnostic features of osteoarticular tuberculosis.MethodsWe reviewed the files of all patients admitted to our department from 2000 to 2015 with a diagnosis of osteoarticular tuberculosis.ResultsWe identified 119 patients (52 men, 67 female), having osteoarticular tuberculosis lesions. Mean age was 43 years [21–82]. Diagnosis delay was 4 months. Pain, low-grade fever and loss of weight were the most common presenting symptoms. All the patients consulted because of pain. The spine was involved in 81 patients. Peripheral osteoarticular tuberculosis was diagnostic in 38 cases, mainly in the knee (21 cases). Five patients have a multifocal involvement of the osteoarticular tuberculosis. The tuberculin skin test was positive in 75% of the cases. The diagnosis of spondylodiscitis was provided by CT-scan and /or magnetic resonance imaging. Paraspinal and epidural abscesses has been reported in 11 cases. Bacteriological and /or pathological diagnosis was made in 72 cases (60.5%). The Quantiferon test was done in 7 cases and was positive. The antibiotic treatment led to recovery in all cases. Tree patients have presented neurological signs.ConclusionsOur results were similar to those of the literature. Elderly population was especially at risk. The idiagnosis can be delayed espacially in negative investigations. Therefore it is recommendable to do a very large screening tests especially in endemic areas.Disclosure of InterestNone declared