Background Ependymoma is a rare adult tumor that originates from ependymal cells of the ventricles and the spinal cord. The diagnosis and management can be very challenging. This study aims to bring out the hypothalamus as an atypical location of ependymoma and to underline the consequences of treatment delay in anaplastic ependymomas through a concrete case. Case presentation We present a case of 20 years with no previous medical history, suffering from progressive intracranial hypertension syndrome, tetraparesis, cerebellar ataxia, and a weight loss of 3 kg in 4 months. Cerebral and medullar Magnetic Resonance Imaging showed multiple processes including the temporal region, the cerebellum, the 4th ventricular floor, the interpeduncular cistern, the hypothalamus, and almost the entire spinal cord, in addition to a posterior intradural lesion. The hypothalamic localization was very suggestive of neurohistiocytosis. A stereotactic biopsy and immunohistochemical study confirmed the diagnosis of anaplastic ependymoma. Total resection was impossible and radiotherapy was delayed by inconclusive dosimetric scans. The patient's outcome was unfortunately quickly fatal. Conclusions Ependymomas should be evoked whatever the location in the central nervous system. Radiotherapy must be quickly discussed and started when the gross total resection is impossible. The locations, as well as the doses of irradiation, are now well-established and any delay in initiating radiotherapy only darkens the prognosis.

The neurological manifestations of HIV infection are very numerous and varied. In 2018, in Morocco, 30% of seropositive subjects are unaware of their infection. Our patient was one of them. Observation: Authors report the case of a 28-year-old woman, widowed at the age of 20 after a traffic accident. In 2009, she moved to Senegal with the onset of chronic consumption of tobacco and alcohol and unprotected sexual relations with multiple partners. The patient was admitted to our training for an insidious symptomatology going back a year, marked by tremor of the head, improved by the alcohol intake, in a context of weight loss not quantified. The examination objectified a statokinetic cerebellar syndrome. Brain magnetic resonance imaging (MRI) did not show any atrophy or cerebellar damage.  The main diagnoses discussed were: sequelae of viral cerebellitis, neurological complications of alcohol intoxication and essential tremor. The complete blood count demonstrated lymphopenia at 660 µL. The HIV and CMV serologies came back positive. Universal meningeal PCR returned VZV. The diagnosis of cerebellar VZV on AIDS was retained. The patient was initially put on Ganciclovir with marked regression of the tremors then on triple therapy after announcement of the diagnosis. Conclusion:  The VZV is the 2nd cause of viral cerebrellitis after the West Nile virus. It can be seen in both the immunocompetent and the immunocompromised. The absence of a concomitant rash is not an exclusion criterion. However, its presence makes diagnostic suspicion easier. Keywords:  head tremor, cerebellitis, HIV, VZV, alcohol, essential tremor.

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Histiocytosis is a rare systemic disease, with heterogeneous and diverse clinical and radiological presentations. Diagnosis can therefore be intriguing. Several consensus recommendations have emerged in recent years, particularly with the advent of targeted therapies, changing the management and prognosis. The authors present two cases of neurohistiocytosis. The case of Langerhans cell histiocytosis was about an adolescent with polyuria-polydipsic syndrome in whom a cerebellar biopsy was inconclusive. The patient was lost to follow-up for one year and then returned with a multisystemic neurological, bone, and dermatological presentation. The diagnosis was confirmed based on skin biopsy results. The patients condition rapidly deteriorated after chemotherapy with vinblastine and corticosteroids, leading to his death. The case of Erdheim-Chester disease was about a 53-year-old man who presented with cerebellar syndrome. His biological and radiological workup showed neurological, endocrine (diabetes insipidus) renal (hairy kidney), and bone (fibrosis) involvement. The diagnosis was confirmed by femoral biopsy and the patient was treated with Cladribine with an excellent evolution with an 18-month follow-up. This manuscript aims to report our personal experience and underline the entitys heterogeneity, non-specificity, and repercussions.