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: 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: 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