Neurobehcet with cerebral aneurysm.

Neuro-behcets disease (NBD) is an uncommon, serious presentation of behcets disease (BD) causing long-term morbidity and mortality. Cerebral aneurysms are rare in BD, with only a handful of cases reported worldwide. A 39-year-old female experienced slurring of speech, numbness, and reduced sensation in the left face, arm, and leg 90 minutes prior to presentation. She provided a history of recurrent oral and genital ulcers associated with intermittent joints pain and blurring of vision. erythrocyte sedimentation rate was elevated, but all other autoimmune workup was negative. Neuro-behcets disease was diagnosed. Brain magnetic resonance imaging demonstrated acute right periventricular infarction. Magnetic resonance angiogram revealed M1 segment stenosis and right internal carotid artery saccular aneurysm. Catheter angiography confirmed its presence measuring 4.8 mm X 6.1 mm. She was stabilized after coiling of the aneurysm and was started on medical therapy. Brain imaging should be carried out in young patients with BD presenting with an ischemic event, and intervention may be lifesaving.

Melioidosis: Can Tropical Infections Present in Nonendemic Areas? A Case Report and Review of the Literature.

Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is an important cause of sepsis in tropical areas of Eastern Asia, mainly affecting immunocompromised adults. Diabetes mellitus is the most important host risk factor. Here, the authors report a case of a 54-year-old Saudi male with uncontrolled diabetes mellitus for 10 years who presented to our hospital with a 6-week history of fever, cough, night sweats and weight loss. The patient was a frequent traveler to the Philippines, with his last visit being during the rainy season 2 weeks before the onset of symptoms. Definite diagnosis of melioidosis was not made because of insufficient facility to culture the organism in our laboratory; nevertheless, a diagnosis of melioidosis was made based on the cumulative clinical scenario. The patient was discharged on trimethoprim-sulfamethoxazole and doxycycline for 3 months and showed significant improvement at follow-up. For prompt diagnosis and treatment, clinicians must maintain a high index of suspicion for melioidosis in febrile patients with a history of traveling to endemic areas, especially diabetic patients.

Cardioembolic Stroke from an Atrial Myxoma in a Pediatric Patient: A Case Report and Review of the Literature.

Cardioembolic stroke is an uncommon phenomenon in pediatric patients. Although the heart is the usual source of the condition, cardiac myxomas are still considered to be a rare cause in children. The case is presented of a 13-year-old, right-handed Saudi boy who showed right-sided weakness for 30 h prior to hospital admission that involved the face, arm, and leg, with slurred speech. The patient had been discharged previously from a local hospital, without active management. An examination showed decreased strength on the right side, with hyperreflexia and an up-going plantar response. The work-up included magnetic resonance imaging, which demonstrated multiple bilateral acute infarcts involving mainly the left cerebellum and a small focus in the right cerebellum. Transthoracic echocardiography demonstrated a left atrial mass measuring 1.9 cm × 2.4 cm, attached to the septum. The mass was resected after anticoagulation, and histopathology confirmed a benign myxoma. This case of cardioembolic stroke was the first to be identified in a pediatric patient in Saudi Arabia, and may easily have been missed. Brain imaging and echocardiography should be performed as soon as possible in such patients in order to guide patient management.