An Unusual First Presentation of Stroke and Seizure in a 32-Year-Old Patient With Brugada Syndrome Type 2 Electrocardiogram Pattern.

We report a case of a 32-year-old lady who was admitted to the hospital with right-sided weakness that preceded an episode of seizure. On the day of admission, she woke up early in the morning with mild right-sided weakness and numbness. She had difficulty walking and later had a seizure, which was witnessed by her son. She had no signs of infection prior to this. She had no fever, chest or abdominal pain, or urinary symptoms. In the emergency department, she complained of left-sided chest tightness and heaviness, which lasted for a few minutes with associated tachycardia, electrocardiogram (ECG) was consistent with Brugada syndrome type 2. A magnetic resonant imaging (MRI) scan of her head shows a left hemispheric infarct involving the frontoparietal cortex. She was treated for an ischaemic stroke and seizure. She made a good recovery and was discharged home on secondary stroke prevention medication with community physiotherapy. She was followed up in the cardiology, genetics, and stroke outpatient clinics. The occurrence of ECG changes consistent with Brugada syndrome, stroke, and seizure in a young patient with no other risk factors for stroke is rare.

A Case of Opiate-Induced Toxic Leukoencephalopathy in a Middle-Aged Woman.

Toxic leukoencephalopathy is a disorder characterized by the alteration of myelin in white matter tracts secondary to exposure to neurotoxic substances. Here we describe a case of a middle-aged woman who presented to the emergency department with a history of bizarre behaviour, speech abnormalities and generalised muscle stiffness caused due to recent opioid overdose. Further investigations and extensive neurological tests, including magnetic resonance imaging (MRI) scan of the brain, demonstrated features consistent with toxic leukoencephalopathy (TLE). The patient was managed conservatively with the care of a multidisciplinary team involving a dietician, physiotherapist and speech and language therapist. She showed gradual and slow but significant recovery following a period of neurorehabilitation. The clinical presentation of TLE varies but MRI typically shows diffuse bi-lateral white matter lesions. History of neurotoxin exposure, presenting clinical signs and symptoms and radiological findings are significant in making the diagnosis. Early recognition is crucial and can help optimize patient's recovery and prevent severe complications.

Pyomyositis Affecting the Paraspinal and Iliacus Muscles in a Patient With Staphylococcus aureus Urinary Tract Infection.

We report a case of a 63-year-old man who presented with a four-day history of fever, night sweats, and left lower back pain, which radiated down to his left buttock and leg. He also had a short-lived episode of chest pain and breathlessness. He had a medical history of chronic back pain, which had been diagnosed as sciatica three years ago. Initial investigations revealed raised inflammatory markers due to a Staphylococcus aureus urinary tract infection. Despite treatment, his inflammatory markers did not improve and the left lower back pain persisted. A magnetic resonance imaging scan demonstrated features consistent with pyomyositis of the left lumbar erector spinae (paraspinal) and iliacus muscles. After prolonged antibiotic therapy, his symptoms completely resolved. Pyomyositis is a rare tropical infection of the skeletal muscles most commonly caused by Staphylococcus aureus. Risk factors include trauma and immunosuppression. This case highlights a nearly missed diagnosis of paraspinal and iliacus pyomyositis in patients with a background history of chronic lower back pain. Early diagnosis and treatment are pivotal in preventing serious complications such as septicemia and multi-organ failure.