Spontaneous intracranial hypotension: an interesting cause of intractable headache

Intracranial hypotension [ICH] is a benign syndrome which is often under-diagnosed. It is characterized by orthostatic headache which is predominantly occipital. ICH is diagnosed in the presence of a typical history and characteristic imaging findings. Further confirmation by Lumbar Puncture to document low CSF pressure is necessary in some cases. Treatment is mainly conservative. However, surgical intervention might be required if conservative measures fail. In this report we present a case of 42 year old male patient who presented with symptoms of orthostatic occipital headache of three months duration and was subsequently diagnosed with Intracranial Hypotension based of characteristic MRI findings

Accessory pancreatic lobe with gastric duplication cyst- A rare case of recurrent acute pancreatitis

Introduction: Hereditary anomalies of the pancreas and the pancreatic duct is not uncommon and can pose a diagnostic challenge. Accessory pancreatic lobe [APL] is a very rare and curable congenital anomaly of the pancreas which can present as recurrent acute pancreatitis [RAP] and association of APL with a gastric duplication cyst is even rarer. To the best of our knowledge, there are only 18 cases reported so far in the world literature and therefore the aim of this article is to highlight the significance of recognising these conditions in clinical practice for avoiding misdiagnosis

Case Discussion We present an interesting case of 28-year old lady who presented with severe abdominal pain with similar episodes in the past but never evaluated before. A possibility of recurrent acute pancreatitis [RAP] was considered, further confirmed on serum amylase, lipase and imaging. CT pancreatography [CTP] followed by MRCP showed an accessory lobe in the head region of pancreas with a separate pancreatic duct associated with a gastric duplication cyst .She was managed as recurrent acute pancreatitis with conservative measures and she improved

Conclusion Prompt identification and understanding of the congenital anomalies related to pancreas and pancreatic duct is imperative as these represent correctable causes of RAP.Moreover, as in our case, the pancreas can have lobulated contours, simulating a pancreatic tumor/tumor deposit or lymphadenopathy. Therefore it is prudent to be aware of this condition to avoid misdiagnosis and to offer appropriate treatment