Bilateral vestibular schwannoma with a cooccurring meningioma in a child: a case report and review of literature.

Introduction: Meningioma and vestibular schwannoma (VS) are the first and second most common benign central nervous system tumors. The coexistence of VS and meningioma presents a rare clinical scenario, particularly in pediatric patients. This report presents a case of bilateral VS with a cooccurring meningioma in a Nepali child and provides an overview of the literature on this condition. Case report: A 15-year-old male presented with bilateral sensorineural hearing loss, seizures, and neurological deficits and was ultimately diagnosed with concomitant bilateral acoustic neuroma and meningioma. The patient underwent radiosurgery for bilateral VS and nonoperative management of the meningioma. Long-term follow-up revealed symptomatic improvement, emphasizing the importance of a multidisciplinary approach in managing such complex cases. The management of these tumors requires tailored treatment strategies guided by tumor characteristics and associated risks. Discussion: Meningioma and VS are common tumors of the central nervous system. Their coexistence is possible in neurofibromatosis type 2 but is exceedingly rare in pediatric age group. The tumors, often coexisting, pose diagnostic challenges. Diagnosis relies on clinical and genetic features, with multidisciplinary management involving various specialists. Treatment aims to preserve function and quality of life, utilizing approaches such as bevacizumab and surgical intervention. The role of radiation therapy remains uncertain. Genetic testing and regular monitoring are vital for early detection and intervention. Conclusion: The cooccurrence of acoustic neuromas and meningiomas is poorly understood, with limited reported cases and unclear pathophysiological mechanisms. Further research into the genetic and molecular mechanisms underlying the coexistence of these tumors is needed to optimize patient outcomes in this rare clinical entity.

Cutaneous larva migrans in a child: a case report and review of literature.

Introduction: Cutaneous larva migrans (CLM) is a dermatitis caused by the invasion and migration of parasitic larvae of hookworms, primarily affecting tropical and subtropical regions. This report presents a case of CLM in a Nepali child and provides an overview of the literature on this condition. Case report: A 4-year-old boy from a rural area in Nepal presented with a pruritic skin lesion on his left foot, initially misdiagnosed as fungal infection. The lesion gradually expanded, forming a serpiginous erythema, and became intensely pruritic. The patient's family had poor socioeconomic conditions, and the child frequently walked barefoot in an area with many domestic and stray dogs. Diagnosis was confirmed clinically, and treatment with oral albendazole and antihistamines resulted in complete resolution of symptoms. Discussion: CLM is a neglected zoonotic disease, with an underestimated burden in developing countries due to underreporting and misdiagnosis. The larvae of Ancylostoma spp. are common culprits, causing a localized inflammatory reaction as they migrate through the skin. Diagnosis is mainly clinical and routine investigations usually reveal no abnormality. Complications may include secondary bacterial infections, allergies, and rare migration to internal organs. Treatment options include albendazole or ivermectin, with preventive measures emphasizing hygiene, footwear use, and pet deworming. Conclusion: CLM is a neglected disease that primarily affects marginalized communities in tropical regions. Raising awareness among healthcare providers, conducting observational studies, and developing treatment guidelines, especially for children, are essential steps to address this public health concern. Preventive efforts, such as promoting hygiene and footwear use, should be encouraged to reduce CLM incidence.

Acalvaria: the first case report from Nepal.

Introduction and importance: Acalvaria is a rare congenital malformation in which the flat bones of the cranial vault, dura mater, and associated muscles are absent while the central nervous system usually remains unaffected. It is an extremely rare congenital anomaly with only a handful of cases being reported in literature. Case presentation: The authors report a case of a 2-month-old male infant with acalvaria who was delivered at home and brought to our centre with the complaint of an abnormally soft skull. He was evaluated in a primary centre in rural Nepal. Parietal bones were missing bilaterally but no other abnormalities were found during the physical examination and investigations. Major differential diagnoses like anencephaly, cephalocele, osteogenesis imperfecta type II, and hypophosphatasia were ruled out with the help of history, physical examination, and available investigations and the case was diagnosed as acalvaria. Clinical discussion: Acalvaria is a post-neurulation defect which is associated with anomalies of various organ systems. Radiological diagnosis, with supportive laboratory investigations, is the most reliable method of antenatal diagnosis. Conclusion: Acalvaria is known to have a dismal prognosis and all the living cases with long-term follow-up are mentally retarded and physically disabled. Early and reliable antenatal diagnosis can reduce the economic, physical, and psychological burden associated with this fatal disease, especially in low-income countries.