Acute Subdural Haemorrhage as a Complication of Diagnostic Lumbar Puncture.

Lumbar puncture (LP) is done daily for both spinal anesthesia and emergency cases for cerebrospinal fluid (CSF) analysis. Subdural hemorrhage (SDH) is a rare but severe complication following diagnostic LP, which could be potentially fatal, and early diagnosis may be life-saving. We present a 28-year-old female patient who presented to our emergency department with a headache, fever, and vomiting, with normal initial laboratory and imaging. Diagnostic lumbar puncture was done to exclude central nervous system infection. After CSF results and cultures were negative, and nasal influenza B detected, medication was started and she was discharged home. Three days post-procedure, she was complaining of a severe, persistent headache and a head computed tomography (CT) was done, which revealed acute SDH. Extensive workup searching for the cause of SDH was negative, and with a stationary course of SDH, she has discharged home again with a diagnosis of SDH post LP complication. In conclusion, a headache post LP is common and usually benign and self-limited. Severe persistent headache that is not positional and doesn't respond to analgesics with caffeine should be considered a red flag after LP and should be investigated carefully for other possibilities such as SDH.

Hemorrhagic Brain Metastasis as the Initial Manifestation of Esophageal Adenocarcinoma.

Esophageal carcinoma metastasis to the brain is very rare with less than 300 cases published worldwide. The reported incidence rates of esophageal carcinoma metastases to the brain range from 0.3% to 13%. It is associated with a worse prognosis than brain metastases from other solid tumors. The most common form of metastasis is cystic lesions while hemorrhagic metastasis represents a rare subset of an infrequent entity. It is extremely rare for esophageal carcinoma to present as an isolated brain metastasis with only three cases reported worldwide. These cases were misdiagnosed as meningitis, a pituitary tumor, and glioma. This paper reports the first case of hemorrhagic brain metastasis as the initial and only manifestation of esophageal adenocarcinoma worldwide. Although extensive work up to search for malignancy is a routine procedure in patients with metastatic brain disease, upper gastrointestinal endoscopy, which is rarely done as part of the work up should be included. Esophageal cancer continues to be challenging to manage with very limited therapeutic options. To date, the clinical outcome after treatment is unsatisfactory, and prognosis is poor. Further research is required to identify better treatment approaches and improve the survival of patients. This paper is an urgent call for action to design chemotherapeutic agents that target tumor cells in the blood and different body organs and has the ability to cross the blood-brain barrier with an acceptable side effect profile. This is mainly because metastatic brain disease has become more common in young age group.

Fatal serotonin syndrome in a patient with Marchiafava-Bignami disease: Combined neurological and psychiatric emergency.

Marchiafava-Bignami disease (MBD) is a rare fatal neurological disorder characterized by demyelination, primary degeneration, and necrosis of the corpus callosum. Although MBD is mostly associated with chronic alcohol consumption and malnutrition, it has been reported in non-alcoholic patients. Serotonin syndrome is a rare but potentially fatal side effect of antidepressants that results from overstimulation of both central and peripheral serotonergic receptors. In this report, we present a case with fatal serotonin syndrome happening in a non-alcoholic patient with the chronic form of MBD. To our knowledge, this case is the first report of fatal serotonin syndrome due to citalopram in an MBD patient. The present report may indicate that citalopram and other SSRIs should not be used in patients with MBD. Our case is also among few reported cases in the literature where no cause was identified in a patient with no previous history of alcohol intake.