Cervical proprioception plays a key role in postural control, but its specific contribution is controversial. Postural impairment was shown in whiplash injuries without demonstrating the sole involvement of the cervical spine. The consequences of degenerative cervical spine diseases are underreported in posture-related scientific literature in spite of their high prevalence. No report has focused on the two different mechanisms underlying cervicobrachial pain: herniated discs and spondylosis. This study aimed to evaluate postural control of two groups of patients with degenerative cervical spine diseases with or without optokinetic stimulation before and after surgical treatment. Seventeen patients with radiculopathy were recruited and divided into two groups according to the spondylotic or discal origin of the nerve compression. All patients and a control population of 31 healthy individuals underwent a static posturographic test with 12 recordings; the first four recordings with the head in 0° position: eyes closed, eyes open without optokinetic stimulation, with clockwise and counter clockwise optokinetic stimulations. These four sensorial situations were repeated with the head rotated 30° to the left and to the right. Patients repeated these 12 recordings 6weeks postoperatively. None of the patients reported vertigo or balance disorders before or after surgery. Prior to surgery, in the eyes closed condition, the herniated disc group was more stable than the spondylosis group. After surgery, the contribution of visual input to postural control in a dynamic visual environment was reduced in both cervical spine diseases whereas in a stable visual environment visual contribution was reduced only in the spondylosis group. The relative importance of visual and proprioceptive inputs to postural control varies according to the type of pathology and surgery tends to reduce visual contribution mostly in the spondylosis group.

Epilepsy is responsible for falls that are not systematically associated with seizures and that therefore suggest postural impairment. There are very few studies of postural control in patients with epilepsy and none of them focus on temporal lobe epilepsy (TLE), although part of the vestibular cortex is located in the temporal cortex. The aim of this study was to evaluate the characteristics of postural control in a homogeneous population of patients with complex partial TLE. Twenty-six patients with epilepsy and 26 age-matched healthy controls underwent a sensory organization test combining six conditions, with and without sensory conflicting situations. Patients with epilepsy displayed poorer postural control, especially in situations where vestibular information is necessary to control balance. In addition to potential antiepileptic drug side effects, vestibular dysfunction could be related to the temporal pathology. Our study allows for a better understanding of the mechanism underlying falls in this population of patients.

This paper presents the design and implementation of wavelet coherence (WC) processor on low cost field-programmable gate array (FPGA). This design is adapted to estimate the wavelet coherence between two EEG signals in a minimal delay in order to support real time applications. The produced CWT coefficients were saved in static RAM chips and prepared for the WC analysis starting with the smoothing operation as an essential computation for the WC algorithm. The WC algorithm was analyzed in the means of choosing the suitable word length for the stages of the design and to simplify the employed functions in the algorithm. Several controllers that handle signal transmission among the design components were designed using hardware description language (VHDL). By using 4 parallel-processing smoothing circuits, the design is capable to calculate the coherogram between two EEG signals (1024 point each) in a total time of 128.64 ms. Image quality methods were applied for coherogram comparison between hardware and software. Hardware results were compared against the rigorous software standard WC according to the following measures; normalized mean square error (NMSE), normalized average difference (NAD) and structural content (SC) are 0.0045, 0.0485 and 0.921 respectively.

Parkinson's disease (PD) is known to affect postural control, especially in situations needing a change in balance strategy or when a concurrent task is simultaneously performed. However, few studies assessing postural control in patients with PD included homogeneous population in late stage of the disease. Thus, this study aimed to analyse postural control and strategies in a homogeneous population of patients with idiopathic advanced (late-stage) PD, and to determine the contribution of peripheral inputs in simple and more complex postural tasks, such as sensory conflicting and dynamic tasks. Twenty-four subjects with advanced PD (duration: median (M)=11.0 years, interquartile range (IQR)=4.3 years; Unified Parkinson's Disease Rating Scale (UPDRS): M "on-dopa"=13.5, IQR=7.8; UPDRS: M "off-dopa"=48.5, IQR=16.8; Hoehn and Yahr stage IV in all patients) and 48 age-matched healthy controls underwent static (SPT) and dynamic posturographic (DPT) tests and a sensory organization test (SOT). In SPT, patients with PD showed reduced postural control precision with increased oscillations in both anterior-posterior and medial-lateral planes. In SOT, patients with PD displayed reduced postural performances especially in situations in which visual and vestibular cues became predominant to organize balance control, as was the ability to manage balance in situations for which visual or proprioceptive inputs are disrupted. In DPT, postural restabilization strategies were often inefficient to maintain equilibrium resulting in falls. Postural strategies were often precarious, postural regulation involving more hip joint than ankle joint in patients with advanced PD than in controls. Difficulties in managing complex postural situations, such as sensory conflicting and dynamic situations might reflect an inadequate sensory organization suggesting impairment in central information processing.

La question de la conscience du point de vue médical — et en particulier neurologique — se pose dans les termes des structures physiques et des processus cérébraux qui en sont le substrat. Ces processus doivent rendre compte de l’unicité de la perception subjective de la conscience et de la multiplicité de ses dimensions analytiques. Ils peuvent être transitoirement ou définitivement altérés selon les contextes pathologiques.Définir l’état actuel de la classification des troubles de conscience pris en charge en réanimation et dans les suites de la réanimation au cours d’une lésion cérébrale grave et les distinguer des autres causes de troubles de la conscience qui peuvent être rencontrés en réanimation.Méthodologie qualitative par revue narrative de la littérature pour illustrer : (i) les risques inhérents d’une interprétation du « coma en réanimation » comme une réalité univoque qui pourrait donner lieu à des interprétations similaires en dépit de l’hétérogénéité des processus observés en période de réveil ; (ii) les écueils épistémologiques et éthiques d’une évaluation comportementale de la conscience ; (iii) les méthodes du pronostic ; (iv) les principes de prise en charge adaptés à chaque étiologie.Les cas de réveil rapide, mais pathologique en réanimation après une période de sédation lourde pour une pathologie extracérébrale ou une lésion cérébrale peu sévère ne provoquant pas directement de trouble de conscience doivent être strictement distingués de l’analyse dynamique des éveils progressifs des patients cérébro-lésés sévères admis avec un coma initial. Ces derniers doivent faire l’objet — avant de pouvoir interpréter le contenu du réveil — d’une évaluation du retour des dimensions de la conscience, et en particulier des capacités cognitives. Le cas des patients cérébro-lésés sans réveil rapide posent des problèmes conceptuels quant à notre capacité à mesurer la conscience sans signe comportemental et sur les meilleurs outils de pronostic.Comportementalement, le coma est un état bien défini qui peut donner l’illusion d’une homogénéité nosologique et conceptuelle. Mais, il peut recouvrir de nombreuses entités physiopathologiques qui doivent être prises en compte dans l’interprétation des processus dynamiques somatiques et psychiques associés à sa résolution.From the medical perspective (in particular for the neurologist's point of view), the concept of consciousness raises two main concerns about its physical structures and the brain-based processes accounting for its material correlate. They should explain both the unicity of the subjective perception of consciousness and the multiplicity of its analytic dimensions. These processes could be transiently or definitely interrupted by pathological causes.To define the current classification of disorders of consciousness managed in the ICU setting and after the ICU period in case of severe brain lesions and to distinguish them from the other causes of consciousness loss that could be observed in ICU.Qualitative method using a narrative review of the literature to illustrate: (i) the risk inherently associated with an unequivocal use of the “coma in ICU” entity that may allow similar interpretations despite heterogenous awakening processes; (ii) the epistemological and ethical concerns about the behavioural assessment of consciousness; (iii) prognosis tools; (iv) the principles of management adapted to each aetiology.Cases of rapid awakening can be pathological because of a prolonged and deep sedation for extra-cerebral diseases or for moderate brain lesions (not responsible for an initial coma). They must be strictly distinguished from the slow but progressive improvement of patients with severe brain injuries admitted for a lesional coma. Before interpreting the content of the awakening subjectivity, the dimension of the conscious process itself, including the patient's cognitive abilities, should be evaluated. These cases of severely brain-injured patients without awakening raise concerns about our ability to assess consciousness without reliable behavioral signs and about the best tools that should be used for prognostication.Coma is a behaviorally well-defined state, which might give the illusion of a nosological and conceptual homogeneity. However, it can include rather numerous physiopathological entities that should be taken into account when interpreting the somatic and psychic dynamics associated with coma resolution.

Antithrombotic (anticoagulants and antiplatelets) are responsible for iatrogenic accidents, with a specific impact in neurosurgery. Bleeding complications are the most common and best-known. But the link to antiplatelet or to dual association of antithrombotic treatment with intracranial haemorrhage is not complete yet. We studied the proportion of patients under antithrombotic treatment, when an intracranial hemorrhage occurred, as well as the morbi-mortality of each group of patients (with or without antithrombotic treatment). Finally, we studied the proportion of off-label prescriptions.We conducted a monocentric and comprehensive prospective study on a group of patients. All patients that had been admitted for intracranial hemorrhage to our hospital, in a 5-month period were included in the study.One hundred and sixty patients admitted for an intracranial hemorrhage were included during 70 days of call. Seventy-four of these patients (46.25%) were under antithrombotic treatment: 40 under antiplatelet treatment (54%), 29 under anticoagulant treatment (39.2%), four under dual antithrombotic treatment (5.4%), and one under Arixtra®. Half of the patients under antithrombotic treatment had poor prognosis as compared to 40% of patients without antithrombotic treatment. Off-label antithrombotic therapy was estimated at 27.3% of all prescriptions.The prevalence of antithrombotic therapy in patients is high when intracranial hemorrhage occurs. Some complications could be avoided by decreasing the number of off-label prescriptions and by better controlling their use (using standardized INR). Antiplatelet treatments and new antithrombotic therapies require better drug monitoring which could be part of the establishment of a specific register.Les antithrombotiques sont à l’origine d’accidents iatrogènes responsables de problèmes spécifiques en neurochirurgie. Les accidents hémorragiques associés aux anti-vitamine K (AVK) sont les plus connus et les plus fréquents. La documentation est incomplète sur l’implication des antiagrégants plaquettaires (AAP) dans la survenue d’une hémorragie intracrânienne (HIC). Nous nous proposons d’étudier la proportion de patients traités par antithrombotiques, lors de la survenue d’une HIC, ainsi que le pronostic à un mois pour chaque groupe de patients (avec ou sans antithrombotique). Enfin, on estimera la proportion d’utilisation hors AMM de ces médicaments.Le schéma d’étude retenu est celui d’une cohorte observationnelle prospective, monocentrique et exhaustive. Tous les patients majeurs présentant une HIC (hors rupture d’anévrisme), pour lesquels un avis spécialisé a été requis, sur une période de cinq mois, ont été inclus dans l’étude.Cent-soixante patients présentant une HIC ont été inclus dans l’étude en 70 jours de garde. Parmi eux, 74 patients (46,3 %) étaient sous traitement antithrombotique (AT) : 40 sous traitement AAP (soit 54 %), 29 sous AVK seul (soit 39,2 %), quatre avec un traitement combinant AVK et AAP (soit 5,4 %), et un sous Arixtra®. Cinquante pour cent des patients sous AT ont un mauvais pronostic contre 40,7 % des patients sans AT et 27,3 % des prescriptions d’AT sont hors AMM.La prévalence de patients sous traitement AT est élevée lors de la survenue d’une HIC. Un certain nombre de complications pourraient être évitable en diminuant le nombre de prescriptions hors AMM, et en contrôlant leur meilleur usage (contrôle d’une INR standardisée). Les AAP et les nouveaux AT nécessitent une meilleure pharmacovigilance pouvant s’inclure dans la constitution d’un registre spécifique.

We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.

Back-ground and Purpose - Intracranial hemorrhages are rare but often fatal complications of anticoagulant therapy The risk of occurrence is related to age, hypertension, and anticoagulation intensity Prognosis factors have not yet been described for subdural hematomas The aim of the study was to determine the factors of poor prognosis in patients presenting with oral anticoagulant-related intracranial hemorrhageMethods - We retrospectively reviewed the medical records of all patients with anticoagulant-related intracranial hemorrhage admitted to our department between 2000 and 2006 The patients' final status (deceased or alive) was analyzed with other risk factorsResults - We identified 186 patients The mean age was 70 6 years One hundred thirteen patients had subdural hematomas For both the overall sample and the subdural hematoma sample, multivariate analysis showed that age and coma were associated with poor outcome Headache was associated with a good prognosisConclusions - Our Study Shows that age and coma at admission were associated With poor outcome in patients presenting anticoagulant Intracranial or subdural hematomas Conversely, headache was a factor for good prognosis as was chronic progression for subdural hematomas. (C) 2009 Elsevier Masson SAS. All rights reserved.

Les hémorragies intracrâniennes au cours d'un traitement anticoagulant sont des accidents rares mais associés à une mortalité élevée. L'âge, l'hypertension artérielle, l'intensité de l'anticoagulation favorisent leur survenue. Les facteurs pronostiques sont mal définis pour ce qui concerne les hématomes sous-duraux. Le but de notre travail était de déterminer les facteurs de mauvais pronostic des hémorragies intracrâniennes associées à un traitement par anticoagulants oraux. Nous avons étudié rétrospectivement 186 patients admis dans notre institution entre 2000 et 2006 pour une hémorragie intracrânienne lors d'un traitement par antivitamine K. L'analyse statistique a été conduite sur l'échantillon global et sur le sous-groupe des hématomes sous duraux. Le critère de jugement principal était binaire et portait sur l'évolution (guérison ou décès) croisé avec différentes variables. L'âge moyen de la population était de 70,6 ans. Cent treize patients présentaient un hématome sous dural. Dans la population globale, l'analyse multivariée retrouvait comme facteur individuel de mauvais pronostic l'âge et le coma à l'admission. En revanche, les céphalées étaient un facteur de bon pronostic. Dans le sous-groupe des patients ayant présenté un hématome sous dural, les mêmes facteurs de mauvais pronostic étaient retrouvés. Le caractère chronique de l'hématome serait un facteur de bon pronostic comme les céphalées. Certains des facteurs pronostiques identifiés ont déjà été mis en évidence pour les hémorragies intracrâniennes en dehors d'un traitement anticoagulant. D'autres comme les céphalées n'avaient jamais été décrits. Notre étude permet de guider la prise en charge thérapeutique de ces patients. Intracranial hemorrhages are rare but often fatal complications of anticoagulant therapy. The risk of occurrence is related to age, hypertension, and anticoagulation intensity. Prognosis factors have not yet been described for subdural hematomas. The aim of the study was to determine the factors of poor prognosis in patients presenting with oral anticoagulant-related intracranial hemorrhage. We retrospectively reviewed the medical records of all patients with anticoagulant-related intracranial hemorrhage admitted to our department between 2000 and 2006. The patients' final status (deceased or alive) was analyzed with other risk factors. We identified 186 patients. The mean age was 70.6 years. One hundred thirteen patients had subdural hematomas. For both the overall sample and the subdural hematoma sample, multivariate analysis showed that age and coma were associated with poor outcome. Headache was associated with a good prognosis. Our study shows that age and coma at admission were associated with poor outcome in patients presenting anticoagulantrelated intracranial or subdural hematomas. Conversely, headache was a factor for good prognosis as was chronic progression for subdural hematomas.

Mit dem UV-Absorber 2-Hydroxy-4-methoxybenzophenon wurden toxikologische Untersuchungen an Ratten durchgeführt. Die akute orale LD50 war grösser als 12,8 g/kg Körpergewicht.Während der 90tägigen Verfütterung des UV-Absorbers in den Konzentrationen 0 (Kontrolle), 0,02, 0,1, 0,5 und 1%im Futter kam es bei Männchen und Weibchen der beiden höchsten Dosierungen zur Depression des Wachstums. Mit Konzentrationen von 0,5 und 1% zeigten die Weibchen nach 6 Wochen Hämoglobinverminderung und Leukozytose bei Zunahme der Lymphozyten und Abnahme der Neutrophilen. Nach 12 Wochen wurden Anämie und Lymphozytose bei Verringerung der Granulozyten festgestellt. Das relative Gewicht von Hypophyse, Thymus, Herz und Nebennieren war in beiden Geschlechtern bei einem Absorber-Zusatz von 1% bzw. 0,5 und 1% geringer. Bei den weiblichen Tieren mit Konzentrationen von 1% im Futter wurde ausserdem eine Erniedrigung des relativen Lungen- und Milzgewichts gefunden. Ein erhöhtes relatives Schilddrüsengewicht wiesen die Weibchen mit einem Zusatz von 0,5% auf. An den Nieren von Männchen und Weibchen der Gruppe mit 1% Absorber-Zusatz wurde makroskopisch und mikroskopischeine “degenerative Nephrose” erkannt. Anfänge einer Nierendegeneration fanden sich auch bei den Weibchen der Gruppe mit 0,5%.Im subchronischen Versuch über 90 Tage wurde ein Absorberanteil von 0,1% im Futter als unwirksame Konzentration ermittelt. Dieser Zusatz entspricht einer unschädlichen Tagesdosis von 0,33 g/kg Körpergewicht Ratte.Toxicity studies on the UV absorber 2-hydroxy-4-methoxybenzophenone were carried out in rats. The acute oral LD50 was greater than 12·8 g/kg body weight.During the feeding of the UV absorber in concentrations of 0 (control), 0.02, 0·1, 0·5 and 1% in the feed for 90-days, growth depression occurred in both males and females on the two highest dosage levels. Females fed 0·5 or 1% for 6 wk showed a lowered haemoglobin level and leucocytosis, with an increase in lymphocytes and decrease in neutrophils. After 12 wk, anaemia and lymphocytosis with a reduction in granulocytes were established. The relative weights of the hypophysis, thymus, heart and adrenals were reduced in both sexes by absorber supplements of 1% or 0·5 and 1%. In females given 1% in the feed, the relative lung and spleen weights were also lowered. Females fed the 0·5% level showed an increase in the relative weight of the thyroid. In the kidneys of both sexes given the 1% absorber supplement, a “degenerative nephrosis” was evident both macro- and microscopically. The first stages of kidney degeneration were found also in females of the 0·5% group.In the 90-day subacute test, an absorber content of 0·1% in the feed was established as the no-effect level. This corresponds to an acceptable daily dose of 0·33 g/kg body weight for the rat.On a étudié sur des rats la toxicité du 2-hydroxy-4-méthoxybenzophénone, absorbeur de rayons UV. La DL50 orale aiguë était supérieure à 12,8 g/kg de poids vif.Les animaux ont reçu l'absorbeur de rayons UV à raison de 0 (témoins), 0,02, 0,1, 0,5 et 1% du régime pendant 90 jours. Un ralentissement de la croissance a été constaté chez les animaux, mâles et femelles, quirecevaient les deux plus fortes doses. Des femelles qui avaient reçu 0,5 ou 1% du produit pendant 6 semaines ont présenté une baisse du taux d'hémoglobine et une leucocytose, avec une augmentation des lymphocytes et une diminution des neutrophiles. De l'anémie et de la lymphocytose avec une diminution des granulocytes ont été constatées après 12 semaines. Les poids relatifs de l'hypophyse, du thymus, du coeur et des glandes surrénales ont diminué chez les deux sexes sous l'effet de suppléments d'absorbeur de 1 ou 0,5 et 1% respectivement. Les poids relatifs des poumons et de la rate ont aussi diminué chez des femelles soumises au régime à 1%. Une augmentation du poids relatif de la thyroïde a été constatée chez des femelles qui avaient reçu la dose à 0,5%. Les reins des animaux des deux sexes soumis au régime à 1% présentaient des symptômes macroscopiques et microscopiques évidents de “néphrose dégénérative”. Les premiers stades de dégénérescence des reins ont été observés aussi chez des femelles du groupe à 0,5%.L'essai de 90 jours entrepris pour déterminer la toxicité subaiguë a permis de situer le seuil d'indifférence à 0,1% du régime. Ceci correspond, pour le rat, à une dose tolérable de 0,33 g/kg/jour.

INTRODUCTION:The prevalence of cerebral cavernomas is about 0.5% in the general population. In contrast, spinal cord cavernomas are considered as rare. The objective of this study was to determine the natural history of spinal cord cavernomas in a multicentric study. METHODS:Clinical and neuroradiological findings were retrospectively collected. Diagnosis was based on pathological criteria or magnetic resonance (MR) findings. RESULTS:Fifty-three patients were included (26 males, 27 females). Mean age at onset of symptoms was 40.2 years (range: 11-80). Initial symptoms were progressive (32) and acute myelopathy (20). One patient was asymptomatic. Clinical symptoms were related to spinal cord compression (24) and hematomyelia (19). Cavernoma location was dorsal (41) and cervical (12.). MR findings consisted of hyperintense signal on T1 and T2 sequences (19 cases), mixed hyperintense and hypointense signal (33 cases), and hypointense signal on T1 and T2 sequences in 1 case. Mean size was 16.3 mm (range: 3-54). Forty patients underwent surgical resection. Improvement was observed in 20 patients and worsening of neurological symptoms in 11. Length of follow up was 7.1 years. At the end of the study, 26 patients were autonomous, 18 handicapped and 1 bedridden. CONCLUSION:This study provided precise data on the clinical and MR patterns of these lesions. The natural history is associated with a higher risk of hemorrhage recurrence, but is favorable in many operated patients. Microsurgery is the treatment of choice for most of these lesions.

Le syringome chondroïde est une tumeur cutanée rare caractérisée par une double composante épithéliale et mésenchymateuse. Le diagnostic histologique morphologique peut être orienté par l’immuno-histochimie. Nous présentons 10 cas et leurs caractéristiques clinico-pathologiques.Dix cas de syringomes chondroïdes ont été inclus, entre janvier 2000 et août 2013, sur les CHU Louis-Mourier et de Fort-de-France. Ils ont tous été relus par un expert en pathologie cutanée et des compléments d’immuno-histochimie ont été réalisés. Les données cliniques et histologiques ont été colligées.Les lésions étaient surtout localisées au visage (3/10) et aux extrémités (3/10). La taille variait de 1,2 à 5,2 cm. Tous les cas ont été traités chirurgicalement, aucun cas de malignité n’a été diagnostiqué. L’histologie montrait un aspect de tumeur dermique limitée, avec une double différenciation syringo-chondroïde, et des cavités revêtues d’une à deux assises cellulaires évoquant une tumeur annexielle de type apocrine (5/10) ou eccrine (4/10). L’étude immuno-histochimique montrait une positivité de l’EMA, l’ACE et de la CK7 sur les cellules bordant les lumières, et une positivité de la PS100 et de la vimentine sur les cellules de la bordure externe.Le syringome chondroïde est caractérisé par une double composante épithéliale et mésenchymateuse au sein d’un stroma myxoïde ou chondroïde. Notre série a des particularités cliniques et histologiques (localisation aux extrémités, raccordement épidermique…). Les principaux diagnostics différentiels sont les autres lésions annexielles, dont l’immuno-histochimie ne serait pas caractéristique de celle des syringomes chondroïdes : les cellules bordant les lumières expriment les marqueurs épithéliaux (EMA, cytokératines et ACE), les cellules de la bordure externe les marqueurs mésenchymateux (PS100, vimentine). Le traitement est chirurgical.L’aspect histologique du syringome chondroïde est évocateur mais en cas de doute la réalisation d’une étude immuno-histochimique montrant une double composante cellulaire peut en faciliter le diagnostic.Chondroid syringoma (CS) is a rare cutaneous tumor characterized by mixte epithelial and mesenchymal component. The confident histological diagnosis can be obtained by immuno-histochemistry study. Here we present 10 new cases with their clinico-hystological characteristics.The 10 cases were observed between January 2000 and august 2013, in Fort-de-France and Louis-Mourier universitary hospitals. For all the cases a controlled histological study was performed by a dermatopathologist expert and immuno-histochemistry was added. Clinical and immuno-histological data were analyzed.The lesions were almost localized on the face (3/10) and the extremities (3/10). The size was about 1.2 to 5.2 cm. Every case was treated by surgery, no malignant case was diagnosed. Histologically, all the 10 cases presented as a well-limited dermic tumor with a mixte epithelial and mesenchymal component. The stroma was myxo-chondroid, and the epithelial component consisted in epithelial cavities lined by one or two cell layers with eccrine (4/10) or apocrine (5/10) features. Immuno-chemistry study reveals positivity for EMA, ACE and CK7 for the internal cells, and positivity for S100 protein and vimentin of the extern cell layer.Chondroid syringoma is characterized by a mixte epithelial with eccrine and apocrine cells and a myxo-chondroid stroma. Our study has some clinical and histological particularities (lesions on the extremities, epidermic connecting…). The main differentials diagnoses are the other annexial tumors. The treatment is surgical.The histological diagnosis of CS is quite easy, but in case of doubt, immuno-chemistry will help, showing a double mesenchymal and epithelial differentiation.