A Rare Case of Varicella-Zoster Virus Meningitis With High Intracranial Pressure in an Immunocompetent Adult.

Varicella-zoster virus (VZV) is an alphaherpesvirus causing varicella (chickenpox) and herpes zoster. While varicella typically presents with a vesicular rash, latent VZV may reactivate within the sensory ganglia causing shingles, characterized by painful vesicular rash, which may lead to neurologic complications such as aseptic meningitis. This case explores an atypical presentation in an immunocompetent young man with VZV meningitis lacking the characteristic skin rash but featuring elevated intracranial pressure. A literature review revealed rare instances of VZV-related neurologic disease without typical skin manifestations, suggesting the virus's potential to affect the central nervous system directly. Treatment with intravenous acyclovir is recommended, with ganciclovir as an alternative treatment option. This case emphasizes the importance of considering VZV meningitis in the differential diagnosis of patients presenting with viral meningitis symptoms, with or without dermatomal rash or immunocompromised conditions.

Psychogenic Dysphagia in an Elderly: A Case of Eating Disorder Due to Trauma and Grief.

Psychogenic dysphagia is a swallowing condition caused by psychological factors rather than structural or physiological disorders such as neurological impairments or physical abnormalities. This condition has a significant impact on a patient's quality of life. Patients should undergo a thorough swallowing evaluation with the involvement of a multidisciplinary team as early intervention leads to satisfactory outcomes. This report presents a case of a 62-year-old female who had severe malnutrition due to psychogenic dysphagia. We evaluated organic and other functional causes of dysphagia, but no abnormalities were detected.

Swallowing Apraxia Post Ischemic Stroke.

A 55-year-old male patient with a known medical history of diabetes mellitus type 2 and treated lymphoma was first admitted with a sudden left-sided facial asymmetry and mouth deviation to the left side with no other neurological symptoms. A Computerized Tomography (CT) scan of the brain showed acute infarct and small left basal ganglia old lacunar infarction. He was discharged on a dual antiplatelet. One week later, the patient's condition had worsened and, therefore, was admitted with an impression of ischemic stroke. A bedside swallowing assessment, VFSS, and FEES study were conducted to diagnose this case. The bedside assessment did not reveal any sensory or motor deficits in his oral cavity and the FEES examination was also unable to rule out pharyngeal dysphagia. However, a videofluoroscopic swallowing study (VFSS) revealed a significant dysfunction of oral preparation and oral phases and presented difficulty initiating the pharyngeal phase. Given these features, we believe that this swallowing difficulty is caused by swallowing apraxia. This case provides additional information and understanding on management from the swallowing side.

Saudi consensus recommendations on the management of multiple sclerosis: MS management in children and adolescents.

Multiple sclerosis (MS) most commonly presents in young adults, although 3-5% of patients develop MS prior to the age of 18 years. The new and comprehensive consensus for the management of MS in Saudi Arabia includes recommendations for the management of MS and other CNS inflammatory demyelinating disorders in pediatric and adolescent patients. This article summarizes the key recommendations for the diagnosis and management of these disorders in young patients. Pediatric and adult populations with MS differ in their presentation and clinical course. Careful differential diagnosis is important to exclude alternative diagnoses such as acute disseminated encephalomyelitis (ADEM) or neuromyelitis optica spectrum disorders (NMOSD). The diagnosis of MS in a pediatric/adolescent patient is based on the 2017 McDonald diagnostic criteria, as in adults, once the possibility of ADEM or NMOSD has been ruled out. Few data are available from randomized trials to support the use of a specific disease-modifying therapy (DMT) in this population. Interferons and glatiramer acetate are preferred initial choices for DMTs based on observational evidence, with the requirement of a switch to a more effective DMT if breakthrough MS activity occurs.