Hypothalamic hamartoma (HH) is a rare congenital, non-neoplastic lesion of the hypothalamus, commonly presents with gelastic seizures, precocious puberty, or both. Gamma Knife radiosurgery (GKRS) has emerged as a minimally invasive treatment option, although long-term outcomes remain incompletely characterized. We report three pediatric patients with HH treated with single-session GKRS and evaluate their long-term clinical and radiological outcomes. All patients presented with gelastic seizures and precocious puberty, accompanied by varying degrees of cognitive, behavioral, or developmental impairment. Lesions were classified as Delalande type II–III, with target volumes ranging from 2.100 to 6.140 cm³. Following GKRS, seizure outcomes were heterogeneous. The first patient achieved substantial seizure control (Engel class ID) nearly four years after treatment, accompanied by cognitive improvement and reduction in antiseizure medication burden. The second patient experienced marked seizure improvement, including two years of complete remission (Engel class IA), but developed late seizure recurrence approximately five years after treatment... Continue Reading

Background: Cavernous sinus syndrome (CSS) is a rare but potentially life-threatening condition caused by a heterogeneous group of neoplastic, vascular, and inflammatory lesions. Its diagnosis represents a significant clinical challenge owing to overlapping presentations and the complex anatomy of the cavernous sinus region. Early and accurate imaging is essential to guide timely management and prevent serious complications including vision loss and stroke. Aims and Objectives: To describe the etiologic distribution and imaging features of CSS in a North African tertiary care cohort, and to evaluate the contribution of multimodal imaging in establishing the underlying diagnosis. Settings: Radiology Department, University Hospital Hassan II, Fez, Morocco (January 2021–December 2024). Methods: Retrospective observational study of 26 consecutive patients evaluated between 2021 and 2024 at University Hospital Hassan II of Fez, Morocco. Morocco. All patients underwent contrast-enhanced CT, and 13 (50%) received 1.5 T MRI with T1-, T2-, FLAIR-, diffusion-weighted, and post-gadolinium sequences; MR... Continue Reading

Background: Idiopathic granulomatous mastitis is a benign, chronic inflammatory disease of the breast that predominantly affects women of reproductive age. It is characterized by non-caseating granulomas involving the mammary lobules. Clinical manifestations range from breast pain and induration, to cutaneous fistulas and breast deformity. In recurrent or extensive disease, management may require radical surgical approaches followed by reconstruction. We report the case of a patient who experienced a relapse after salvage surgery in the remote donor area (abdomen), raises questions about whether the initial diagnosis of idiopathic granulomatous mastitis was incorrect, and whether what the patient presented from the beginning corresponded to a skin or connective tissue manifestation secondary to her autoimmune disease. Case Presentation: A 28-year-old female presented with a two-year history of multiple emergency department visits for recurrent mastitis, treated with various antibiotic regimens, with late diagnosis of systemic lupus erythematosus and idiopathic granulomatous mastitis who underwent bilateral... Continue Reading

Background: Acute motor axonal neuropathy (AMAN) is a severe Guillain-Barré syndrome (GBS) variant that may deteriorate rapidly, particularly when early bulbar weakness and respiratory failure occur. Cerebrospinal fluid (CSF) protein may remain normal early in the disease course, and coexisting upper-airway findings can create diagnostic uncertainty. Case Presentation: A 43-year-old previously healthy man developed severe dysphagia, sialorrhea, and nasal speech after febrile pharyngitis, followed by rapidly progressive limb weakness. Examination showed flaccid tetraparesis, preserved sensation, and evolving bulbar dysfunction. Nasopharyngoscopy demonstrated mild non-obstructive epiglottic inflammation, initially suggesting an upper-airway or infectious cause. Within 24 hours, he developed ineffective cough, neck flexor weakness, and impending respiratory failure requiring intensive care admission and endotracheal intubation. Post-intubation examination showed generalized areflexia and autonomic instability. Day 1 CSF showed no pleocytosis and normal protein. Day 2 nerve conduction studies demonstrated severe predominantly motor axonal polyneuropathy with relatively preserved sensory responses, consistent with AMAN. Intravenous... Continue Reading

Background: Sea snake bites are uncommon but potentially life-threatening emergencies due to the neurotoxic and myotoxic effects of their venom. Antivenom remains the mainstay of treatment; however, it may rarely cause severe hypersensitivity reactions, including anaphylaxis. Case Presentation: A 34-year-old previously healthy male presented to the emergency department in Oman 1.5 hours after a confirmed sea snake bite sustained while fishing. Initial examination revealed a fang mark on the right foot without significant local swelling. Shortly after initiation of intravenous antivenom, the patient developed vomiting, lethargy, hypotension, oxygen desaturation, and a generalized tonic-clonic seizure. Antivenom administration was immediately discontinued, and the patient was treated with intramuscular epinephrine, intravenous hydrocortisone, fluid resuscitation, and supportive care. The seizure resolved promptly, and he recovered without neurological sequelae. Laboratory investigations demonstrated mild leukocytosis and a transient rise in creatine kinase levels. Computed tomography of the brain was unremarkable. The temporal relationship to antivenom infusion,... Continue Reading

Background: Large urinary bladder (UB) calculus is now rare in urological clinical practice. UB stone presents with obstructed urinary flow, increased urinary frequency, and lower abdominal and perineal or penile pain. Male patients are affected more. Hot environmental condition, poor water intake, benign prostatic enlargement, urethral stricture, and prolonged urethral catheterization are some of the contributory factors for bladder stone formation. Herein, we have tried to highlight importance and need of open cystolithotomy in five cases of large UB calculus presented to outpatient department (OPD) with their clinical presentation, history, and investigations with probable causes and review of literature.Case series: Five consecutive patients were evaluated, diagnosed, and operated for giant UB calculus by open cystolithotomy. Patients were discharged with suprapubic catheter (SPC) and per-urethral catheter (PUC) in situ. SPC and PUC were sequentially removed after 3 weeks of surgery. All five patients had intact UB stone removal except one where... Continue Reading

Background: Lemierre syndrome is a rare but potentially life-threatening condition classically characterized by recent oropharyngeal infection, septic thrombophlebitis of the internal jugular vein, and septic embolization. However, severe deep neck infections may occasionally present with clinical features that mimic Lemierre syndrome, even when internal jugular vein thrombosis, septic embolization, and positive cultures are absent.Case Presentation: A 21-year-old previously healthy man presented to the emergency department with altered mental status following a two-week history of sore throat. Fever, chills, dyspnea, and confusion had developed within the previous 24 hours. On admission, he was febrile, tachypneic, confused, and poorly cooperative. Laboratory investigations revealed neutrophilic leukocytosis and elevated inflammatory markers. Contrast-enhanced neck computed tomography demonstrated a right-sided peritonsillar/parapharyngeal abscess measuring 18 × 28 × 54 mm with obliteration of the parapharyngeal fat planes. However, no evidence of internal jugular vein thrombosis or septic pulmonary embolism was identified. The patient was admitted to the... Continue Reading

Background: Co-occurrence of dextro-transposition of the great arteries (D-TGA) and severe hypertrophic cardiomyopathy (HCM) is an exceptionally rare and hemodynamically precarious scenario. While transient, reversible HCM is well-documented in neonates of diabetic mothers, idiopathic biventricular HCM presenting late in infancy introduces unique physiological barriers.Case Presentation: We present the case of a 4-month-old, non-diabetic infant diagnosed with parallel circulation D-TGA, complicated by massive biventricular hypertrophy, a large ventricular septal defect, and flow-related pulmonary hypertension.Discussion: The contemporaneous presentation of these pathologies creates a vicious hemodynamic cycle: the excessive volumeand pressure loading from unrestrictive shunts collide with severe intrinsic biventricular hypertrophy, culminating in profound diastolic dysfunction and severely restricted inter-circulatory mixing. This case underscores that, unlike transient neonatal HCM, late-presenting non-diabetic hypertrophy combined with high-volume pulmonary overcirculation renders traditional bridging and corrective therapies physiologically intolerable.Conclusion: We detail the profound surgical limitations in this subset of patients - specifically the theoretical contraindications for pulmonary... Continue Reading

Background: Flail arm syndrome (FAS) is an uncommon variant of amyotrophic lateral sclerosis (ALS) characterized by progressive, predominantly lower motor neuron weakness confined mainly to the upper limbs. Because structural cervical disease is common in older adults, its diagnosis may be delayed or misattributed to compressive or peripheral nerve disorders. Case Presentation: A 69-year-old man developed progressive asymmetric upper limb weakness over two years, evolving into bilateral brachial diplegia with preserved lower limb function. Neurological examination showed marked upper limb atrophy, fasciculations, and extensor plantar responses, without sensory deficits. MRI showed no significant cervical compression, while electromyography revealed multisite denervation, supporting the diagnosis of flail arm syndrome as a phenotype of ALS. Multiple alternative diagnoses, including cervical myelopathy, multifocal motor neuropathy, and myopathy, were systematically excluded. Conclusion: This case highlights the importance of recognizing flail arm syndrome within the ALS spectrum. Electrophysiological evidence of multisite motor neuron involvement is crucial... Continue Reading

Background: Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei. Its protean manifestations may mimic chronic infectious or inflammatory conditions, including HIV infection, leading to diagnostic pitfalls. Case presentation: We report the case of a 51-year-old man presenting with a one-month history of severe weight loss, chronic diarrhea, and asthenia. Initial evaluation revealed a weakly reactive fourth-generation HIV screening assay, raising concern for HIV infection; however, confirmatory HIV PCR was negative. Cross-sectional imaging showed diffuse small-bowel wall thickening, mesenteric lymphadenopathy, ascites, and pleuropericardial effusions. Upper gastrointestinal endoscopy revealed friable ulcerated duodenal mucosa with villous blunting. Duodenal biopsies demonstrated periodic acid–Schiff-positive foamy macrophages, and polymerase chain reaction confirmed Whipple’s disease. The patient received intravenous ceftriaxone followed by oral doxycycline and hydroxychloroquine, with rapid clinical improvement and no evidence of relapse at six months of follow-up. Conclusion: This case highlights Whipple’s disease as an important differential diagnosis in patients with... Continue Reading