No abstract

Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is a rare trigemino-autonomic cephalalgia characterized by unilateral, periorbital, neuralgiform attacks of short duration accompanied by prominent autonomic dysfunction. Treatment of SUNCT can be challenging and is often ineffective.A 57-year-old man had a 3-month history of intense left periorbital pain, ipsilateral conjunctival injection, and tearing, occurring 5-10/hour and lasting 30 -120 seconds (video), refractory to several medications. Attacks could occur spontaneously or be provoked by mouth movements during talking or chewing. Brain MRI revealed left trigeminal nerve compression (figure, A). Microvascular decompression separated an aberrant loop of the superior cerebellar artery from first division of the trigeminal nerve root (figure, B). The patient has remained asymptomatic off medication since.SUNCT bears several similarities with first division trigeminal neuralgia, but unlike trigeminal neuralgia, symptomatic cases usually appear with posterior fossa and diencephalic lesions.1 In our patient, typical attacks were found in relation to first division trigeminal nerve compression. In such cases, surgical decompression may provide complete resolution of symptoms.

Spinal epidural abscess due to Mycobacterium tuberculosis is the least common of the various forms of spinal tuberculosis. This abscess represents a severe infection of the epidural space that can compromise neural elements and can require urgent surgical intervention to avoid permanent neurological deficits. Early diagnosis and early decompression remain the 2 most important predictors of a successful neurological outcome.

This is a case report of pyogenic sacroiliitis in a pediatric patient caused by Streptococcus intermedius. The patient is a 16-year-old boy who presented to an emergency department with sudden onset of back pain radiating to the left lower extremity. The diagnosis was confounded by the presence of isthmic spondylolisthesis. Plain radiography demonstrated mild isthmic spondylolisthesis but no radiographic signs of tumor, trauma, infection, arthritis, or other developmental problems. The C-reactive protein level was 23 mg/L. Over the next 24 hours, the patient developed fever, and the C-reactive protein level increased to 233 mg/L. Sacroiliitis and an iliopsoas abscess were identified on MRI. Blood cultures grew S intermedius. The patient responded to antibiotic treatment and needle aspiration under CT guidance. Sacroiliitis is an uncommon condition and, to our knowledge, there is only one other case report of its being caused by S intermedius. The previous report was in an adult.

Bilateral luxatio erecta remains a rare condition, with less than 30 cases currently described in the literature. The authors present a case of bilateral inferior glenohumeral dislocation after a fall with low-energy trauma, treated with closed reduction and immobilization for 3 weeks followed by a physiotherapy program for functional rehabilitation. After 1 year of follow-up, the patient presented satisfactory results with a complete recovery of the previous mobility arch of both shoulders.