Year 2021, Volume 5 - Issue 5

Background: The clinical syndrome of headache and neurological deficits and cerebrospinal fluid lymphocytosis (HaNDL) is recognized as a self-limiting condition consisting of discrete episodes of neurological deficit associated with moderate to severe headache. The spectrum of neurological features most commonly include aphasia, sensory, and motor disturbances. However, confusion and agitation has also been described. Case Presentation: We present an unusual case of a 28-year-old male with recurrent hospital presentations for headache, confusion, and other neurological stigmata over a period of 15 days, culminating in a diagnosis of HaNDL following extensive investigations. He was treated empirically for viral encephalitis initially; however, there were no positive results on virology screening. In addition, autoimmune screens were also negative. He was then managed symptomatically and discharged from hospital with resolution of symptoms thereafter. Conclusion: The differential diagnoses for transient acute confusional disorders remain expansive, with HaNDL being one of the many rare causes. Rigorous testing is required to exclude infective, inflammatory, ischemic, structural, or iatrogenic pathology, whil HaNDL primarily remains a diagnosis of exclusion.

Background: Mucoceles are self-limiting mucus-containing cavities that is caused by mechanical trauma to the excretory duct of the gland, which leads to pooling of saliva into the surrounding tissues. They may vary according to its clinical presentations, depending on its depth of involvement. They are usually asymptomatic. Sometimes they may show change in size due to rupture and subsequent mucin accumulation. They more frequently occur in relation to the lower lip. Case Presentation: We present a case report of mucocele on the ventrolateral aspect of the tongue, which is a rare occurrence. Even though it clinically resembled a mucocele, diagnostic confirmation was done after histopathological examination. Conclusion: Although surgical excision is the treatment of choice, removal of all the adjacent minor salivary glands is required to prevent the recurrence. They pose a diagnostic and therapeutic challenge to the clinician as well as surgeon due to its clinical resemblance with other lesions of the tongue. So, a thorough clinical knowledge as well as the determination of varying aspects of the etiopathogenesis of these oral lesions is necessary for correct diagnosis and for the indication of appropriate treatment.

Background: Though tuberculosis strictures are the most common cause of acute intestinal obstruction, in rare patients, malignant strictures are found in the jejunum causing acute intestinal obstruction and biopsy of these strictures came out to be jejunal adenocarcinoma. Case Presentation: In this case series, we presented three cases of jejunal adenocarcinoma who presented in the emergency department with sign and symptoms of acute intestinal obstruction and peritonitis. All were operated and samples were sent for histopathology which shows jejunal adenocarcinoma in all three cases. Patients were sent to oncology department for adjuvant radiotherapy. Fortunately, all patients responded well to radiotherapy and post op follow up was satisfactory. Conclusion: Although a rare entity, the operating surgeon should keep a high suspicion for malignancy in cases of acute intestinal obstruction if strictures are found in jejunum and cancer directed surgery technique should be followed because this timely treatment is the best survival offer for the patient in otherwise aggressive disease.

Background: Peritoneal dialysis can be associated with various mechanical complications. Among them, pleuroperitoneal leak leading to recurrent hydrothorax is a lesser known entity. The condition can lead to life-threatening complications like respiratory distress, cardiac failure, arrhythmias, and infections. Various imaging modalities like computerized tomography, magnetic resonance imaging, and nuclear scans have been used to establish the diagnosis of pleuroperitoneal leak. Case Presentation: An elderly gentleman with multiple co-morbidities on peritoneal dialysis presented with recurrent hydrothorax. After ruling out cardiac, infective, and neoplastic etiologies as causes for hydrothorax, the diagnosis of pleuroperitoneal leak was established using computerized tomography peritoneography. Despite temporarily interrupting peritoneal dialysis, our patient developed recurrent hydrothorax, thus requiring to be transferred to hemodialysis. Conclusion: A high index of clinical suspicion and choice of the imaging modality will help in the timely diagnosis of pleuroperitoneal leak and appropriate therapeutic intervention.

Background: Endogenous endophthalmitis (EE) is a rare but potentially blinding ocular infection caused by hematogenous spread from a remote primary source. Case Presentation: A 30-year-old woman presented in eye outpatient department (OPD) with the loss of vision, redness, and purulent discharge in both eyes for 3 days. Detailed history revealed that the patient had 2 months of pregnancy for which she underwent a surgical abortion 5 days back in a hospital of local area followed by intense bleeding per vagina. On ocular examination, patient denied for light perception and an area of corneal thinning was present in the center in both eyes. Fundus examination revealed absence of normal red glow bilaterally. On general physical examination, patient was found to be semiconscious, hypotensive; pulse was feeble, and patient was in stage of shock. Medical management for the ocular condition was initiated and patient was referred to emergency department immediately. Follow ups continued in the ICU for the ocular condition. Conclusion: To conclude, it could be said that minor procedures may sometimes lead to life threatening complications; thus, full antibiotic prophylaxis should be given before initiation of any (major or minor) surgical procedure to reduce incidences of postoperative morbidities.

Background: Herniation of urinary bladder through the inguinal canal is a rare disease that requires surgery. The resulting combination of failure of the abdominal wall and an increase in intra-abdominal pressure occurs prolapse of the urinary bladder in the inguinal canal and the occurrence of inguino-scrotal hernia. Case Presentation: This phenomenon is very rare and often misdiagnosed. It occurs more often in older men with increased body weight and symptoms of distal urinary obstruction and urinary infections. The symptoms usually are mild to moderate, associated with hindered urination and urinary infections, and if this condition is promptly left untreated it can lead to serious health problems, such as renal failure. computed tomography reconstruction in three planes is the method of choice in the diagnosis of inguino-scrotal hernia of the bladder. Conclusion: This method provides a clear display of the herniated part of the urinary bladder and allows detection of the contents of the hernia sac.

Background: Coronavirus disease 2019 (COVID-19) typically causes breathing issues that can range from flu symptoms to extreme pneumonia but can also impair extra respiratory systems and cause multisystemic failure, including neurological complications. Case Presentation: A 55-year-old male with acute progressive symmetrical ascending quadriparesis complaints was admitted to the hospital. Twelve days prior to hospitalization, the patient with taste disruption, myalgia, fever, and polymerase chain reaction with reverse transcription (RT-PCR) was confirmed to have been positive for COVID-19 infection. The neurophysiological findings were consistent with the diagnosis of Guillain-Barre syndrome (GBS). Conclusion: COVID-19 activates inflammatory cells and creates a number of inflammatory cytokines and eventually produces immune-mediated processes. Both cell and humoral-dependent pathways of GBS pathogenesis are believed to be related. peripheral nervous system myelin, axons and, in some cases, both immune-mediated attacks are believed to be the cause of molecular expression. COVID-19 is believed to induce antibody formation against particular gangliosides. Further study is needed to understand the role of GBS caused by infection with COVID-19.