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Archives de pédiatrie
Volume 19, n° 11
pages 1196-1199 (novembre 2012)
Doi : 10.1016/j.arcped.2012.08.022
Received : 11 April 2012 ;  accepted : 21 August 2012
Présentation neurologique d’un ostéome ostéoïde du col fémoral
Neurological manifestations of an osteoid osteoma located on the femoral neck in an 8-year-old boy
 

S. Cabasson a, , M. Yvert b, P. Pillet c, J.-M. Pédespan a
a Unité de neurologie de l’enfant et de l’adolescent, hôpital Pellegrin-Enfants, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France 
b Service de radiologie pédiatrique, hôpital Pellegrin-Enfants, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France 
c Service des urgences pédiatriques, hôpital Pellegrin-Enfants, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France 

Auteur correspondant.
Résumé

L’ostéome ostéoïde est une tumeur osseuse bénigne fréquente de l’enfant. La présentation clinique comprend des douleurs articulaires sensibles à l’aspirine. Cependant des formes à présentation neurologique peuvent exister, et rendre le diagnostic difficile. Nous rapportons le cas d’un enfant de 8ans qui présentait une boiterie aux dépens de la jambe gauche évoluant depuis plusieurs mois, associée à une amyotrophie du quadriceps et des gastrocnémiens. L’enfant souffrait de douleurs d’allure neurogène à l’aine gauche, avec un horaire de type inflammatoire. Les réflexes ostéotendineux achilléens et rotuliens étaient diminués du même côté. Il n’y avait pas d’anomalie sur la jambe et la cuisse droites. L’imagerie par résonance magnétique (IRM) et la tomodensitométrie ont mis en évidence un ostéome ostéoïde du col fémoral gauche. Ce cas illustre également l’efficacité de la prise en charge en radiologie interventionnelle par radiofréquence percutanée, qui permet une récupération rapide.

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Summary

We report the case of an 8-year-old boy, suffering from nocturnal pain localized on the left groin and presenting as a limp over several months. Examination revealed diminished strength of the left leg, atrophy of the thigh and calf, and a diminished deep tendon reflex. The pain could be intense and the patient had found an analgesic position by pushing on his groin or by flexing his thigh on the pelvis. He could no longer run. He was unsuccessfully treated with carbamazepine and gabapentin. His evaluation included a negative abdominal ultrasound study and a normal spine and cerebral MRI. Electromyography was unremarkable. He finally underwent an MRI of the pelvis that revealed a hyperintense T2 signal of the left femoral neck; CT confirmed the diagnosis of osteoid osteoma. Radiofrequency ablation of the lesion was performed. His clinical state dramatically improved after the procedure. His walk is normal, without any limping. Deep tendon reflexes are normal, and he only presents residual pain. Physicians should be aware that osteoid osteoma may take the form of a slowly evolving neuropathy. We review the literature on this underestimated condition.

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© 2012  Published by Elsevier Masson SAS.
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