Spontaneous Cerebral Air Embolism-An Unusual Scenario.

The introduction of air into cerebral venous or arterial circulation known as cerebral air embolism (CAE) is a rare clinical entity. CAE is commonly iatrogenic secondary to central venous catheter (CVC) placement or removal, various endoscopic procedures, or trauma or surgical scenarios. Here we report a case of spontaneous CAE in an unusual scenario. A 71-year-old male presented to emergency after developing giddiness following a yoga session. His MRI showed air embolism in the posterior fossa along cerebellar folia, prepontine, and suprasellar cisterns and tracking superiorly along the tentorium cerebelli. CAE is a rare clinical entity. Our case had CAE as a complication of cholesteatoma and possibly got triggered due to change in air pressor dynamics during yoga session.

Paraplegia during coronary artery bypass graft surgery caused by bilateral anterior cerebral artery territory infarction.

Paraplegia is a rare complication after coronary artery bypass graft (CABG) surgery mostly caused by spinal cord ischemia. Even rarer is the paraplegia following infarction involving both anterior cerebral artery (ACA) territories caused by embolism during coronary artery bypass graft surgery. This case has become even more interesting as cerebral vasculature involving internal carotid and anterior cerebral arteries was absolutely normal.

Chronic meningitis with multiple cranial neuropathies: A rare initial presentation of Wegener's granulomatosis.

Wegener's granulomatosis (WG) is a systemic necrotizing vasculitis that affects the small blood vessels. It mainly affects the upper and lower respiratory tract and kidneys. Central nervous system (CNS) involvement is rare, and has been reported only in about 8% of cases during the course of illness. Initial presentation with neurologic affection, particularly chronic hypertrophic meningitis is very unusual. We report the case of a 34 year old male who presented with chronic hypertrophic meningitis and multiple cranial nerve involvement as the initial manifestation, without respiratory and renal symptoms. This case highlights the difficulties in diagnosing a rare disease with rarer presentation, and at the same time illustrates that Wegener's granulomatosis should be considered in the differential diagnosis of chronic meningitis.

Recurrent stroke in a case of left atrial myxoma masquerading vasculitis.

We report a case of left atrial myxoma presenting as recurrent neurological deficits with absent peripheral pulses mimicking systemic vasculitis. Due to absence of cardiac signs and symptoms, there was one year delay in diagnosis from initial symptom. Left atrial myxomas are rare but treatable cause of recurrent stroke.