Purpose The purpose of this study is to (a) assess the effectiveness of culturally tailored diabetes prevention interventions in minority populations and (b) develop a novel framework to characterize four key domains of culturally tailored interventions. Prevention strategies specifically tailored to the culture of ethnic minority patients may help reduce the incidence of diabetes. Methods We searched PubMed, EMBASE, and CINAHL for English-language, randomized controlled trials (RCTs) or quasi-experimental (QE) trials testing culturally tailored interventions to prevent diabetes in minority populations. Two reviewers independently extracted data and assessed risk of bias. Inductive thematic analysis was used to develop a framework with four domains (FiLLM: Facilitating [i.e., delivering] Interventions through Language, Location and Message). The framework was used to assess the overall effectiveness of culturally tailored interventions. Results Thirty-four trials met eligibility criteria. Twelve studies were randomized controlled trials, and 22 were quasi-experimental trials. Twenty-five out of 34 studies (74%) that used cultural tailoring demonstrated significantly improved Hemoglobin A1C, fasting glucose, and/or weight loss. Of the 25 successful interventions, 21 (84%) incorporated at least three culturally targeted domains. Seven studies used all four domains and were all successful. The least utilized domain was delivery (4/34) of the intervention’s key educational message. Conclusions Culturally tailoring interventions across the four domains of facilitators, language, location, and messaging can be effective in improving risk factors for progression to diabetes among ethnic minority groups. Future studies should evaluate how specific tailoring approaches work compared to usual care as well as comparative effectiveness of each tailoring domain. Registration (PROSPERO registration: CRD42015016914)

We present a case of new onset bilateral lower extremity weakness, paresthesia, urinary retention and bowel incontinence in a 51-year-old man. He had a complicated history of acute myelogenous leukemia with known central nervous system (CNS) and leptomeningeal involvement status post allogenic stem cell transplant complicated by chronic graft versus host disease (GVHD). We review the differential diagnosis as the physical exam and diagnostic results evolved. We also provide a review of the relevant literature supporting our favored diagnosis, as well as other competing diagnoses in this complicated case. The ultimate differential diagnosis included viral myelitis, treatment-related myelopathies, and CNS GVHD. The case provides a sobering reminder that even with an appropriate diagnostic workup, some cases remain refractory to therapeutic efforts. It also underscores the importance of a sensitive neurologic exam, given the significant clinico-radiological delay, and reviews the complex differential diagnosis for myelopathy.

Summary A 61‐year‐old man with past medical history significant for prediabetes, hyperlipidemia and high‐grade prostate intraepithelial neoplasia presents with headaches for one month. Imaging of his brain reveals hydrocephalus and spine imaging reveals a cord lesion. These findings are discussed further in the case.

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A 29-year-old woman with a history of shingles presented with a 3-month history of headaches and diplopia. She was in her usual state of health until 3 months prior to presentation, when she first developed severe headaches. Headaches were localized to the left periorbital area and left temple. They were described as "stabbing" in nature. Initially, she was having daily headaches, which would wake her up from sleep.She denies any visual aura, photophobia, phonophobia, nausea, or emesis. She denies eye tearing, rhinorrhea, or conjunctivitis. She also denies fevers/chills and neck pain/stiffness. Headaches are not associated with changes in position.About 2-3 weeks after onset of headaches, the patient developed binocular diplopia. In particular, she noted the diplopia was worse with leftward gaze and with objects greater than 30-60 cm away. Her boss also noticed her left eyelid was drooping around this time, which resolved by the time of presentation.On exam, her left eye was unable to fully abduct with far-left gaze. On downward gaze, her left eye had a subtle hypertropia. Her left eye ptosis had resolved. Otherwise, the rest of her neurologic exam was intact. Her pupils were 4 ? 2 mm bilaterally. Visual fields were intact to finger counting. On fundoscopic exam she had sharp disc margins OU. There was no ptosis bilaterally. Extraocular movements were intact in the right eye.Her magnetic resonance imaging (MRI) brain showed T2 signal hyperintensity in the left cavernous sinus, with ill-defined, asymmetric enhancement with extension of mild enhancement (Figure 1). Vessel and sinus imaging was without any evidence of thrombosis. Her cerebrospinal fluid (CSF) studies were bland (white blood cell 2 and 1, protein 26, glucose 61, all infectious, cytology, and inflammatory markers negative). All serum studies were negative or within normal limits as well, including an autoimmune panel, Lyme disease, human immunodeficiency virus, and vasculitis labs. Her symptoms improved after a course of steroids.Diagnosis: Tolosa-Hunt syndrome.Take-home points:A. The cavernous sinus contains several key anatomic structures, including cranial nerves III, IV, VI, and the opthalmic and maxillary branches of V. Cranial nerve VI runs medially, inferior to the cavernous portion of the internal carotid artery.