Quadricuspid pulmonic valve (QPV) is almost always a benign anomaly and is therefore usually discovered incidentally on radiographic studies or post-mortem at autopsy. Because of its rarity, the true extent of the physiology of QPV is not fully understood, and the few reported cases of it may underestimate its physiological consequences. In this case, we report on a young active-duty solider who presented for a well check-up and was discovered on imaging to have a QPV. We also review the most recent literature and provide recommendations regarding the most effective diagnostic modalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s40779-015-0037-2) contains supplementary material, which is available to authorized users.

Leptospirosis is a zoonotic disease transmitted by fresh water and mammalian vectors in predominantly tropical regions, with an incidence of 0.1-10 per 100,000 in temperate climates, 10 or more per 100,000 in tropical climates, and up to 100 or more per 100,000 during outbreaks. Its rate of transmission spikes in areas affected by natural disasters such as floods and heavy rainfall and, because it often presents with non-specific symptoms, it can be difficult to diagnose. The case fatality rate in severe leptospirosis from <5 -30% makes it a pathogen of clinical importance. This review aims to summarize the most recent literature on the subject and provide recommendations to providers who may encounter afflicted patients.

Vertebral artery dissection is of special clinical importance because of its often-delayed presentation and the risk of potentially permanent neurological deficit, or even death, as a result of injury. Once a rarely discovered injury, the better availability and use of computed tomography and magnetic resonance imaging have contributed to an increased incidence. Early diagnosis and treatment can almost eliminate the threat of acute cerebral vascular injury and save lives. In this report, we review a case of delayed traumatic vertebral artery dissection and discuss the key clinical findings and management strategies.

Introduction: Ramsay Hunt syndrome is a rare complication of varicella zoster virus (VZV) reactivation, occurring in only approximately 0.2% of VZV reactivation cases. Despite its rarity, the morbidity associated with the syndrome is high, and the symptoms can be varied and nonspecific. Case Report: This report presents the case a 42-year-old female with an atypical presentation of Ramsay Hunt syndrome. Initially, her symptoms were concerning with regard to stroke; however, stroke workup was normal, and the consultants considered her symptoms to be the most consistent with Ramsay Hunt syndrome. Conclusion: The classical symptoms of Ramsay Hunt syndrome include otalgia; a vesicular rash in either the auditory canal, hard palate, or anterior two-third of the tongue; and ipsilateral facial paralysis or weakness. Our literature review revealed that there were no similar case reports; however, all emergency physicians should include this syndrome as part of the differential diagnosis of patients who present with unilateral paralysis.

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