A 36-year-old man had orthostatic headache and bilateral hygromas secondary to spontaneous intracranial hypotension (SIH). An epidural blood patch temporarily improved symptoms. Three weeks later, he presented with impaired consciousness and severe progress on MRI, which showed a new cerebellar tonsil herniation and increased hygromas (Figure 1, B and D). A ventral dural tear was missed on digital subtraction myelography (DSM) in prone position (Figure 2A) but was clearly demonstrated on subsequent cone-beam CT (CB-CT) by rotation of the C-arm within 3 seconds (Figure 2B). This technique has not been described previously to detect a ventral dural tear in patients with SIH. CB-CT provides cross-sectional images with high spatial resolution and can be performed immediately after DSM to confirm or exclude unclear findings.1 Multiphase CT-myelography is available as diagnostic alternative but usually requires high radiation dose.2 The leak was confirmed by surgery, and the patient recovere

A 6-year-old boy experienced sudden-onset neck pain followed by rapidly progressive weakness in all 4 extremities. Physical examination demonstrated port-wine stains over the nuchal area (Figure 1A). Neurologically, the patient was quadriplegic, lacking deep tendon and cremasteric reflexes, with a sensory level corresponding to C4 segment. Spinal MRI revealed a large extradural-intradural AVM lesion associated with hematomyelia in the cervical spine (Figure 1B), better depicted by catheter angiography (Figure 1C). Based on the data obtained thus far, a diagnosis of spinal arteriovenous metameric syndrome (SAMS) was made. After starting prednisolone therapy followed by endovascular embolization, the quadriparesis improved, and physiotherapy helped the patient regain full strength a month later.

A 48-year-old man presented with 3 days of progressive ascending numbness, paresthesias, and gait instability in the setting of recreational nitrous oxide inhalation. The initial examination showed decreased sensation to light touch, pinprick, vibration, and proprioception in all 4 extremities,

A 73-year-old man presented with recurrent encephalitis/stroke-like episodes over the past 23 years. Multimodality CT indicated an asymmetry lesion, presenting with cerebral edema, hyperperfusion, and gyrus-like enhancement in the left cerebral hemisphere (Figure 1, A–C). Furthermore, vessel density increased on the left side (Figure 1D). MRI showed that the lesions were mainly distributed in the cortex of the frontal, parietal, temporal, occipital, and insular lobes of the left hemisphere (Figure 2, A and B). In addition to these cortical lesions, bilateral white matter lesions were also revealed (Figure 2C), and diffusion kurtosis imaging confirmed the injury of white matter tracts (Figure 2D). The patient was diagnosed with neuronal intranuclear inclusion disease based on the findings of eosinophilic spherical inclusions positive for anti-p62 in the nucleus of neurons in the left hemisphere, as well as 70 repeats in NOTCH2NLC . Two months later, he could raise the right arm but stil

A 40-year-old man with no medical history presented with several months of progressive language disturbance. He had immigrated from Mexico 3 years earlier. Examination was notable for expressive aphasia and subtle right-sided upper extremity weakness. MRI brain demonstrated multiloculated, enhancing, noncalcified, left hemispheric, cystic lesions. He underwent surgical debulking; PCR confirmed presence of Taenia solium . Subsequently, he was treated with dexamethasone, albendazole 15 mg/kg/d for >1 year, praziquantel 50 mg/kg/d for 3–6 months, and levetiracetam for postoperative seizures (Figure 1). Three months later, his deficits had resolved; MRI demonstrated decrease in cystic lesions (Figure 2).

A 30-year-old man presented with a single unprovoked convulsion and a 5-year history of recurrent, severe right-sided flank pain of unclear etiology. Workup over the course of his presentation included multiple subspecialist evaluations, including emergency room visits to rule out nephrolithiasis. Other differentials included dystonia, radiculopathy, and musculoskeletal pathology.