Late-Stage Fabry Disease With Advanced Cardiomyopathy and Conduction Disorders.

Fabry disease, a well-known X-linked disorder, can present as an elusive late-stage disease in women with challenging limitations to management. Risk stratification of patient populations for genetic testing, early detection, and advances in affordable clinical treatment are on-going. We present a case to further demonstrate the need for continued research. Our case involved advanced complications, including worsening diastolic heart failure and conduction disorders ranging from supraventricular tachycardia to severe heart block. The patient received goal-directed medical therapy as tolerated for her heart failure and ultimately needed a dual-chamber pacemaker with a defibrillator.

Case Report: Neurocysticercosis Acquired in Australia.

Neurocysticercosis (NCC) is a disease caused by infection of the central nervous system with the larval stage of the tapeworm Taenia solium. This disease is endemic in many parts of the world, including Africa, Asia, and Latin America, where animal husbandry practices are common such that pigs reared for human consumption ingest feces from humans infected with T. solium. Neurocysticercosis is rarely acquired in economically affluent regions, including North America, Central Europe, Japan, and Australasia, and in countries where pork consumption is discouraged by religious or social practices. In these countries, NCC is usually diagnosed in immigrants or returning travelers who have spent time in endemic regions. Here, we report a case of NCC in a 25-year-old woman presenting with worsening visual symptoms in association with headache, diagnosed previously as a migraine with visual aura. This person had always lived in Australia and had never traveled overseas to a country endemic for T. solium. The unusual features of the clinical presentation and epidemiology are highlighted to raise physicians' awareness that attention needs to be paid to the risk of autochthonous infection occurring in non-endemic countries.

Mirror writing after perimesencephalic subarachnoid haemorrhage.

We report a case of a right-handed Caucasian woman who developed mirror writing following a non-aneurysmal, non-traumatic subarachnoid haemorrhage. The patient was unaware of having this phenomenon, and it was detected by clinical staff when the patient was writing a card to a family member. Serial imaging has ruled out a stroke as well as an underlying vascular abnormality. This phenomenon resolved after two months. Whilst there is a body of literature surrounding mirror writing, to our knowledge, this is the first description of mirror writing in the setting of a perimesencephalic subarachnoid haemorrhage.

Ovarian hyperstimulation syndrome leading to ventriculoperitoneal shunt malfunction: Case report.

Ventriculoperitoneal shunt (VPS) insertion is a common neurosurgical procedure for hydrocephalus. Unfortunately, VPS malfunction is not uncommon, with an estimated cumulative rate of 32% at 5 years. As flow through the shunt is influenced by the pressure gradient between the ventricles and the peritoneal cavity, malfunction may be caused by elevated intra-abdominal pressure. We present a rare patient with ascites following ovarian hyperstimulation syndrome (OHSS) leading to shunt malfunction. OHSS is a potentially life-threatening complication of controlled ovarian stimulation caused by the administration of exogenous gonadotropins. In this patient clinical and radiological resolution of shunt dysfunction were achieved following peritoneocentesis. To our knowledge this is the first described case of OHSS leading to shunt malfunction, emphasizing the importance of awareness, early recognition and proper management of abdominal etiologies of VPS malfunction.