Resistant Tremors and Unexplained Weight Loss Could Also Be a Sign of HIV

This case study is done to show a different type of presentation of a HIV (Human Immunodeficiency Virus) patient. Neurological symptoms in HIV are normally due to Progressive Multifocal Leukoencephalopathy (PML) which is a reactivated infection caused by John Cunningham virus (JC virus). The disease causes fatal demyelination of the central nervous system (CNS). This case presented a 51-year-old Nigerian man who complained of resistant tremors and unexplained weight loss. The patient was suspected to have HIV when a MRI scan revealed T2/FLAIR hyper intensity of white matter which was a sign of PML. HIV ELISA was done and came back with a positive result. PML presenting in the form of tremors is very rare and more research is required to focus on the neurological presentation of HIV.

Acute Massive Gastric Dialation—A Case Report

Acute gastric dilation leading to ischemia of the stomach is an underdiagnosed condition and can be potentially fatal. It can occur in various medical and surgical conditions such as post operative state, trauma, anorexia, spinal abnormalities, diabetes mellitus and electrolyte imbalance. Without proper and timely diagnosis and treatment, gastric perforation and hemorrhage can occur. In this report, we present a case of acute massive gastric dilation in a settling of type II diabetes mellitus and urosepsis. We will also present a review of literature and management options for such condition. Our report highlights the need for high index of suspicion and early intervention to avoid life threatening complications.

Could Dystonia Be Initial Presentation of Corpus Callosum Infarction in Young Age Patients? A Case Report Study

Focal dystonia in young aged patients is considered to be the uncommon clinical presentation, unless a secondary cause is to be considered. Infarcts of the corpus callosum are rare and have not been well documented previously. As for a variety of signs and symptoms due to corpus callosum lesion, focal dystonia can be easily overlooked. The case is approved by ethical committee and explained to the patient with patient approval.

Spontaneous Intracranial Hypotension: An Interesting Cause of Intractable Headache

Intracranial hypotension (ICH) is a benign syndrome which is often under-diagnosed. It is characterized by orthostatic headache which is predominantly occipital. ICH is diagnosed in the presence of a typical history and characteristic imaging findings. Further confirmation by lumbar puncture to document low CSF pressure might be necessary in some cases. Treatment is mainly conservative in the form of bed rest and intravenous saline infusion. However, surgical intervention may be required if conservative measures fail. In this report we presented a case of 42-year-old male patient who presented with symptoms of orthostatic occipital headache of three-month duration and was subsequently diagnosed with intracranial hypotension based on characteristic MRI findings of pachymeningeal enhancement on gadolinium enhanced MRI of the brain with sagging of the mid-brain.

Acute Cerebellar Ataxia—Uncommon Manifestation of Typhoid Fever

Enteric fever is widely prevalent in the tropics. Central nervous system involvement is not rare and reported incidence varies from 5% to 35% [1]. Various well-known neuropsychiatric manifestations include confusional state, encephalopathy, meningism, convulsions and focal neurological deficits. Acute cerebellar ataxia as an isolated neurological complication of enteric fever is very rare and limited to only a few case reports [2]. Here we report a case of enteric fever who presents Acute Cerebellar Ataxia.

Empty Sella Syndrome: A Case Report and Literature Review

An empty sella occurs due to herniation of the arachnoid through an incompetent diaphragma sellae. Over time, cerebrospinal fluid (CSF) pulsations may enlarge the sella and compress the gland against the floor of the sella. Empty sella syndrome is considered as a less common entity and is usually asymptomatic and an incidental finding. However, it can be a manifestation of increased intracranial pressure and can be occasionally severe. Compression of the pituitary gland may affect function, or traction on the optic chiasm and nerves may cause visual symptoms. An empty sella may be classified as primary when this occurs in persons who have not received pituitary radiation or pituitary surgery, while an empty sella discovered following such procedures is classified as secondary empty sella. In this report, we presented a 41-year-old multiparous patient who presented to us with symptoms of headache and left sided hemi-sensory disturbance. Examination was unrevealing except for the fact that she was obese. On evaluation, she was detected to have impaired blood sugars, dyslipidemia and vitamin insufficiency. MRI brain revealed presence of Empty Sella. Further hormonal analysis was normal. She was treated conservatively and regular follow-up was advised.

Case Report on Hiccup and Lateral Medullary Syndrome

The case study is aimed at providing a more thorough analysis of a case of lateral medullary syn-drome presented only with persistent hiccup after eating lunch the study hopes to generate an interest for further studies into the topic and focuses on abnormal unusual presentations of lateral medullary syndrome. Ethical committee has approved this case after taking consent from the patient and explaining to him the importance of the case in clinical practice.

Extensive Cannon Ball Metastases—A Case Study of a 49-Year-Old Bulgarian Male

Multiple pulmonary nodules on chest x-ray, known commonly as cannon ball secondaries, are the classical presentation of haematogenous dissemination of a malignant tumor to the lungs. This almost always indicates advanced stage of the disease with a very grim outlook in terms of cure or survival. In this report we present a patient with very extensive Cannon Ball Metastases due to advanced colonic malignancy.