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Esophageal carcinoma is considered a common malignancy across the globe. These patients usually present with an advanced stage of the disease at the time of diagnosis. Herein, we report a 55-year male patient who presented with leptomeningeal carcinomatosis, detected on cerebrospinal fluid (CSF) cytology in a case of adenocarcinoma lower third esophagus. On radiological imaging, he also had extensive metastatic deposits in the liver, pleura, and regional and paravertebral lymph nodes.Primary central nervous system lymphoma (PCNSL) is a rare neoplasm with an incidence of 2 to 3% of all CNS malignancies. The diagnosis can be challenging, especially with atypical presentations. Movement disorders can be one of the rare presentations of PCNSL. Here, we present an unusual case of gradually progressing Parkinsonism with an elevation of cerebrospinal fluid (CSF) 14-3-3 protein and atypical imaging findings found to have PCNSL. A 76-year-old female patient presented with gait and intermittent speech difficulty. Initial workup revealed a contrast-enhancing lesion in the bilateral putamen and head of caudate without any mass effect. Her symptoms were rapidly progressed over 6 months and presented with mild dysarthria, bradykinesia, mild rigidity, and reduced left arm swinging. These features were consistent with Parkinsonism. The repeat imaging showed the progression of hyperintensities in the bilateral putamen. The patient underwent a stereotypic biopsy of the right caudate nucleus, which revealed PCNSL. She was treated with high-dose methotrexate and is currently in remission. Diagnosis of movement disorders remains clinical and rapid progression of symptoms, and atypical presentation must warrant further imaging and workup.A 36-year-old female patient presented to our stroke neurology clinic for progressively worsening intractable, sharp, shooting interscapular pain radiating to the right shoulder and neck, which she had experienced for 4 years. She had previously seen an orthopedist and was referred to a neurosurgeon for surgical intervention after an MRI of the cervical spine showed the C3-C4 right vertebral artery loop protruding into the right C3-C4 neural foramen and compressing the exiting C4 nerve root. MR neurography showed a stable tortuous right vertebral artery loop, causing a mass effect on the dorsal root ganglion. A neuroforaminal decompression surgery was planned. However, the patient visited our stroke neurology clinic for a second opinion before surgery. An MRI of the thoracic spine showed an enhancing soft tissue mass at the right T4-T5 pedicles and adjacent body. A chest CT with contrast showed a 1 cm radiolucent lesion in the superior articular facet of T5, which represented a nidus. A technetium bone scan showed focal increased uptake within the right T5 pedicle, which is indicative of osteoid osteoma. The patient underwent laminectomy/resection and was pain-free at a 6-month follow-up; biopsy confirmed osteoid osteoma. This case illustrates the importance of neurolocalization during diagnostic testing.Wernicke's encephalopathy is an acute neurological disorder caused due to thiamine deficiency. It is characterized by a triad of confusion, ataxia, and ophthalmoplegia. learn more Wernicke's encephalopathy can present with atypical clinical manifestations, particularly in setting of nonalcoholic background. Our patient manifested with clinical complaints of acute drowsiness, speech difficulty, and ataxia. Magnetic resonance imaging of the brain revealed T2 hyperintensity in bilateral medial thalami, globus pallidus, periaqueductal gray matter, dorsal pons, and dorsal medulla. The diagnosis of Wernicke's encephalopathy was entertained and he well responded to parental thiamine therapy. The clinician should be aware about atypical presentation of Wernicke's encephalopathy.Head injury associated with orbital trauma is commonly encountered in day-to-day practice. We report a rare case of orbital trauma resulting in isolated orbital "roof blow" in fracture in a 14-year-old child. The patient presented to us with diplopia and limitation of elevation of right eye after orbital trauma. Computed tomography of the orbits (2 mm sections) did not reveal fracture of the orbital floor. However, there was orbital roof "blow in" fracture with fracture fragment impingement on the superior rectus muscle. Patient was treated conservatively and spontaneous recovery of ocular motility was noted after a month.Dupuytren's disease is a progressive fibrotic condition of the hand. The underlying pathomechanism is not fully known. Dupuytren's contracture can be seen in patients with diabetes mellitus, chronic alcoholism, smoking, or hand trauma. It is uncommon to affect the neurovascular supply causing clinical symptoms. We describe a patient with idiopathic Dupuytren's disease complicated with bilateral ulnar neuropathies and highlight the importance of such rare treatable complication.On March 11, 2020, the World Health Organization declared the SARS-CoV-2 outbreak to be a pandemic which has sent all countries in a frenzy. We cannot be callous about treatment of non-COVID-19-related patients. The Wardha district of Maharashtra is a declared "dry area" which makes the sale, purchase, and consumption of alcohol illegal. On March 24, 2020, Indians were informed of a 21-day long lockdown which was subsequently extended for another 3 weeks during which all modes of public transportation, educational institutions, offices, and other nonessential businesses were closed and people expected to remain at home unless necessary. Since then admissions of alcohol-dependent patients showed a spike from14% in the prelockdown period to 27% of patients of alcohol dependence syndrome. It is most likely due to poor availability of liquor, inability to earn money to buy the alcohol, or restricted movement of individuals.Neurotrauma is a critical public health problem that deserves the attention of the world health community. The unprecedented pandemic of SARS-COV 2 has led to a tremendous strain on medical facilities including intensive care and availability of blood products. In addition, due to lockdown in most nations and diverting of medical attention elsewhere, neurotrauma has taken a back seat. Despite this, any case of trauma presenting during this time should receive the best possible care. However, it is also imperative to safeguard the health care workers from this infection, too. The number of health care workers losing their lives to this infection is ever rising. We here present a possible workflow using a checklist approach such that errors and cross-infections are minimized and there is no reduction in the level of care received by any trauma case. This article has been written with a special focus on middle-income countries where resources may already be strained due to the sudden case burden. We hope to minimize death "caused" by COVID-19 and "related" to it.
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