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Angiolipomas (ALs) are hamartomas composed of abnormally differentiated vessels and mature adipose tissue. Although they are most commonly found in peripheral tissues, ALs sometimes grow in the spinal epidural space. Intracranial ALs (ICALs) are rare: only seven cases have been reported in the literature. The authors describe the case of a 70-year-old woman who presented with ocular symptoms from a clinically and radiologically progressing parasellar ICAL. The radiological as well as the microsurgical findings are illustrated and compared with the seven previously published cases. The most frequent location of ALs is the skull base, especially the parasellar region. Other ICALs were diagnosed as components of cerebral arteriovenous malformations and were not symptomatic by themselves. Neuroradiological studies of ICALs usually demonstrate the characteristics of both adipose and vascular tissues. However, a review of the literature shows that the diagnosis had not been suspected preoperatively in any of the cases. Operative descriptions emphasize that most neurosurgeons were caught off guard by the profuse bleeding and the unusual relationship of this unexpected lesion to the cavernous sinus, so that removal was rarely complete. The authors conclude that preoperative diagnosis of ICALs is achievable based on magnetic resonance analysis, which should help optimize the microsurgical management of these lesions.

Background Occipital nerve blocks are commonly used in the treatment of different types of refractory headaches. The procedure is considered safe, and serious complications have rarely been described. Case presentation We report a serious complication of occipital nerve blockade secondary to the penetration of local anesthetic and non-steroidal anti-inflammatory drugs into the posterior fossa in a patient affected by type I Arnold Chiari malformation. Conclusions This case reminds that a proper injection technique is mandatory to avoid potentially severe complications when performing occipital nerve blocks.

Introduction: We report an adult man who developed an isolated long thoracic nerve palsy three days following vaccination against COVID-19. To the best of our knowledge this is the first well-documented case of this association. Case presentation: A 46-year-old white man developed back pain, followed by pain in the right axilla and scapular region, clumsiness of the right arm and unusual position of his shoulder blade, three days after receiving a second dose of the Pfizer-BioNTech COVID-19 vaccine. When he consulted a neurologist six months later, the pain had subsided, but the other symptoms persisted despite physiotherapy. Main clinical findings were right scapular winging and marked amyotrophy of the serratus anterior, with preservation of the other muscles of the shoulder and scapula. Nerve conduction studies of the long thoracic nerve yielded a low amplitude with a slightly prolonged latency. Needle electromyography showed decreased compound motor action potentials on the right was normal with a few polyphasic waves on the left. Main diagnosis and interventions: A diagnosis of post-immunisation long thoracic neuritis was made. The patient was treated with physiotherapy. Conclusions: Clinicians should be aware of the possibility of neuritis of any nerve after COVID-19 vaccination.

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