Lymphomatosis cerebri (LC) is a rare variant of primary CNS lymphoma characterized by diffuse fluid-attenuated inversion recovery (FLAIR) hyperintensity on MRI. A 71-year-old woman presented with a 1-month history of nausea. On admission, she showed no focal neurological deficits except dizziness. MRI revealed diffuse FLAIR hyperintensity from the cerebellar vermis to the midbrain involving the right temporal and parietal lobes, accompanied by partial diffusion-weighted imaging (DWI) hyperintensity and no gadolinium enhancement. 18F-fluorodeoxyglucose positron emission tomography demonstrated no abnormal uptake, and CSF analysis demonstrated elevated β2-microglobulin (MG) levels and an MYD88 mutation on cell-free DNA that leaked into the CSF. A targeted biopsy of the DWI-hyperintense region confirmed CD20-positive diffuse large B-cell lymphoma. She underwent therapy with rituximab, methotrexate, procarbazine, and vincristine followed by high-dose cytarabine, achieving temporary remission; however, relapse occurred 1 month after consolidation therapy. Tirabrutinib was initiated, resulting in complete radiological resolution for 5 months. LESSONS Diffuse white matter abnormalities without enhancement should raise suspicion of LC and prompt targeted biopsy, particularly from DWI-hyperintense regions. CSF β2-MG and MYD88 mutation analysis provide valuable diagnostic clues for distinguishing LC from malignant glioma. This case also suggests a potential therapeutic role for tirabrutinib in early-relapsing LC. https://thejns.org/doi/10.3171/CASE26337.

Wilson's disease is an autosomal recessive disorder of copper metabolism that primarily affects the liver and brain, with onset typically in early adulthood. Pediatric presentations are rare, and the atypical presentation of psychiatric symptoms can delay the diagnosis process in low-resource settings. Epidemiological data on the disease, particularly in Syria, remain scarce. Early diagnosis is necessary to prevent irreversible hepatic and neurologic damage. An eight-year-old Syrian child presented with psychiatric and neurologic symptoms, including increased aggressiveness, learning difficulties, dysarthria, drooling while eating and drinking, and difficulty speaking, followed by weight loss and jaundice. A dental examination revealed no temporomandibular joint deformities, prompting neurological consultation. The neurological examination revealed difficulty walking with limb tremors and speech impairment. Laboratory findings showed slightly elevated transaminases and total iron-binding capacity with low serum iron, indicating hepatic dysfunction. Serum ceruloplasmin was markedly reduced (3.1mg/dl), and 24-h urinary copper excretion was elevated. MRI of the brain revealed increased T2-weighted signal intensity in the caudate and lentiform nuclei. An ophthalmologic exam found Kayser-Fleischer rings at the corneal limbus. Esophagogastroduodenoscopy showed distal esophageal varices, and an abdominal ultrasound showed hepatomegaly and splenomegaly. The patient was treated with copper chelator penicillamine, dietary copper restriction, and physical therapy. Follow-up showed marked clinical improvement with recovery of motor function, improved speech, and resolution of jaundice. This instance underscores the necessity of evaluating Wilson's illness in pediatric patients exhibiting early behavioral and neurological signs, particularly emphasizing that prominent psychiatric manifestations may precede hepatic signs even in young children. Early administration of chelation therapy can lead to excellent outcomes even in resource-limited settings. Atypical presentations require increased awareness that may facilitate earlier detection and the prevention of irreversible organ damage.

The present study describes an outbreak of Streptococcus canis (S.canis) infection in a commercial mink farm in West Macedonia, Greece, and investigates its clinical, pathological and microbiological features.In late February 2024, approximately 300 out of 5,100 mink (5.9%) developed purulent abscesses primarily located on the head, while some animals exhibited neurological signs, including depression, weakness and lethargy. The farmer reported similar incidences in animals also the previous year. Necropsy revealed localized abscessation, and purulent meningoencephalitis was observed in two cases. Bacteriological culture followed by Oxford Nanopore Technologies sequencing confirmed the presence of S. canis in all examined samples. Antimicrobial susceptibility testing demonstrated potential clinical efficacy of ampicillin and erythromycin.The recurrence of the outbreak and its seasonal pattern suggest the involvement of predisposing factors such as environmental stress and trauma associated with housing conditions. Clinical response to ampicillin supports its continued efficacy against S.canis, while resistance to selected non-β-lactam agents highlights the value of antimicrobial susceptibility testing when alternative therapies are considered.These findings support a potential pathogenic role of S.canis in farmed mink, including cases with neurological involvement, and underline the need for improved management practices and further investigation into its epidemiology in farmed mink populations.

Inborn errors of immunity (IEIs), an expanding group of monogenic disorders with diverse clinical manifestations, are increasingly recognized to include neuroinflammatory disease. Examples of diseases included under this umbrella are Aicardi-Goutières syndrome, deficiency of adenosine deaminase 2, familial haemophagocytic lymphohistiocytosis, neonatal-onset multisystem inflammatory disease, and acute necrotizing encephalopathy, among others. Children with IEIs may develop encephalopathy, seizures, focal neurological deficits, aseptic meningitis, inflammatory lesions on magnetic resonance imaging, or other central or peripheral nervous system manifestations. While systemic features of autoinflammation or autoimmunity are often present and provide important clues that an underlying IEI may be present, neuroinflammation may be the presenting or sole manifestation in some children. Early recognition of neuroinflammatory presentations of IEIs is critical to prompt immunological and genetic investigations, enabling diagnosis and timely initiation of appropriate immunotherapies, and reducing the risk of long-term neurological outcomes. This review highlights paediatric-onset neuroinflammatory phenotypes associated with IEIs and provides practical frameworks for their recognition and investigation in clinical practice.

ABSTRACTTuberous sclerosis complex (TSC) is a rare autosomal dominant disorder characterized by multisystem hamartomas caused by pathogenic variants in TSC1 or TSC2. It is typically diagnosed in childhood, most often because of neurological or dermatological manifestations. Diagnosis in late adulthood is uncommon and may pose significant diagnostic challenges. We report the case of a 59‐year‐old woman who presented with lumbar pain. Abdominal computed tomography (CT) revealed multiple bilateral renal angiomyolipomas (AMLs), more prominent in the right kidney. Further evaluation identified multiple facial angiofibromas and a periungual fibroma. Renal function was preserved, and no neurological, pulmonary, cardiac, or ophthalmological involvement was detected. Based on the International TSC Consensus diagnostic criteria, the diagnosis of TSC was established on clinical grounds. The patient underwent right renal tumorectomy without complications, and histopathology confirmed angiomyolipoma. Sirolimus therapy was initiated 3 months later to reduce the risk of progression of residual lesions. This case highlights that TSC may remain unrecognized until late adulthood and that renal angiomyolipoma can be the presenting feature. Clinicians should systematically evaluate adults with angiomyolipoma for underlying TSC, even in the absence of overt neurological signs. Early recognition is essential to ensure appropriate surveillance and prevent potentially serious renal and systemic complications.

Incidence and Risk Factors of Sport-Related Concussion in Amateur Handball Players: Findings from the PRECCOCE Study.

Cerebral hemangioma is a recognized cause of acute onset of epileptic seizures with interictal neurological abnormalities in dogs, although the number of cases reported is limited. Hemangiomas can affect dogs of all age groups, but there is an increasing risk with age, peaking at nine years. This case report describes a 5-month-old female Chow Chow dog with an acute onset of epileptic seizures and interictal neurological deficits indicative of a right forebrain lesion due to a cerebral hemangioma and associated hemorrhage. Initially, extracranial causes were excluded, and magnetic resonance imaging of the head was performed, revealing a large well-delineated hemorrhagic mixed intra- and extra axial lobular mass in the right frontal lobe, generalized ventriculomegaly, and two intraventricular smaller, well-defined cyst-like structures in the right cerebellopontine angle and fourth ventricle. The dog was euthanized due to the severity of neurological deficits combined with imaging findings, suggesting a poor prognosis. Post-mortem gross examination, histopathology, and immunohistochemistry identified the larger structure as a hemangioma accompanied by extensive hemorrhage. The significant hemorrhage likely explained the acute onset of neurological signs. It is probable that the hemangioma might have remained subclinical, had this hemorrhage not occurred. The smaller cyst-like structures were identified as multilocular ependymal diverticula originating from the fourth ventricle. This case report underlines the importance of considering cerebral hemangiomas accompanied by acute hemorrhage as a possible differential diagnosis in cases with an acute onset of epileptic cluster seizures with accompanying interictal neurological signs, here found in a juvenile dog.

Cerebral tuberculoma is an infrequent but life-threatening manifestation of tuberculosis whose diagnosis and treatment are uniquely complicated by pregnancy-related physiological changes. Evidence to guide clinicians remains fragmented and largely anecdotal. We systematically searched MEDLINE, LILACS and grey literature to May 2025 for reports of cerebral tuberculoma in pregnant or postpartum women. Twenty-seven studies (24 case reports, 2 descriptive studies, 1 case series) from 20 countries met inclusion criteria, yielding individual-level data on 33 patients. Demographics, clinical features, diagnostics, management and maternal-fetal outcomes were extracted and synthesized. Median maternal age was 26 years (IQR 23-29). Diagnosis occurred ante-partum in 45% and post-partum in 55%, at a median gestational age of 31 weeks. Headache (59%), fever (56%) and seizures (48%) predominated; cranial-nerve palsies (54%) and focal paresis (50%) were common neurologic signs. Magnetic resonance imaging (MRI) revealed solitary or multiple contrast-enhancing lesions, chiefly supratentorial but infratentorial in 35%. Cerebrospinal fluid (CSF) showed proteinorrachia (n = 10/15) and mononuclear pleocytosis (n = 8/12, 66.67%); positivity of CSF or biopsy interferon-γ release assays (100%, n = 3/3) outperformed CSF culture (33.3%, n = 3/9) and CSF polymerase chain reaction (PCR; 12.5%, n = 1/8). Standard four-drug therapy plus corticosteroids was administered in 97%, typically > 12 months; 60% underwent neurosurgical biopsy or resection. Maternal mortality was 4.6%, and persistent neurological sequelae occurred in 33.3% of cases (n = 7/21). Among 26 live pregnancies, preterm delivery occurred in 72%; neonatal complications affected 50%, including congenital tuberculosis (17%) and neonatal death (17%). Although cerebral tuberculoma during pregnancy is rare, delayed recognition contributes to substantial maternal morbidity and adverse neonatal outcomes. Our synthesis underscores the diagnostic value of advanced imaging and CSF interferon-γ assays, supports prolonged first-line therapy with adjunctive steroids, and highlights critical gaps in evidence-based guidelines. Multicentre prospective registries are urgently needed to refine diagnostic algorithms and optimise maternal-fetal care.

Preclinical identification of the underlying causes in emergency patients with predominant disability (D)-problem is often unreliable, leading to misallocation and capacity issues in intensive care and stroke units. To address these challenges, the management of these patients, including acute stroke care, is increasingly shifting to emergency departments or emergency centers. This results in ahigher proportion of patients with D‑problems requiring immediate evaluation within the framework of anon-traumatological resuscitation room; however, astandardized care concept for this patient group in the non-traumatological resuscitation room is lacking. To optimize time-critical acute care for emergency patients with predominant D‑problems in the non-traumatological resuscitation room, the "neurological emergency receiving team" (NERT) was established at the University Emergency Department of the University Hospital Freiburg. The NERT concept aims to enable rapid and systematic evaluation and treatment of patients with acute focal neurological deficits and/or unexplained impairment of consciousness through predefined diagnostic and therapeutic pathways. Aspecialized team was formed comprising experts from neurology, emergency medicine and emergency nursing. In close collaboration with (neuro)radiologists experienced in emergency diagnostics, the team provides acute in-hospital care for this time-sensitive patient population. This article describes the team's composition, responsibilities, and workflow within the NERT concept. The NERT concept enables rapid and standardized management of patients with predominant D‑problems. Interdisciplinary and interprofessional collaboration improves the time to diagnosis and initiation of treatment while reducing the risk of misallocation. The NERT concept represents afeasible model for delivering efficient and high-quality emergency care to patients with D‑problems in the non-traumatological resuscitation room.

The present case report describes the clinical and pathological outcomes of an outbreak of piglet mortality and neuromuscular disorders in newborn and nursery piglets caused by vitamin B5 deficiency. A farrow-to-wean 750 sow-farm in Spain experienced abortions and respiratory signs in sows related to swine influenza during the first week of February 2025. It was followed by an unusual high piglet mortality rate within the first week post-farrowing, reaching up to 65% and persisting for seven weeks. Piglets were born apparently healthy, and colostrum intake was considered normal. Nevertheless, on the second day of life, they started showing apathy, ataxia, and prostration, most of them usually dying spontaneously on the third day of life. At the same time, at least 14 recently weaned piglets exhibited similar clinical signs and subsequently died. However, sows were completely unaffected. Initial antibiotic treatments were ineffective. Seven piglets were subjected to a complete necropsy. Five showed the above-mentioned neurological signs and two were completely healthy, which served as non-affected control animals. No relevant gross lesions were found. Histopathologically, neuronal bodies from cervical, thoracic, and lumbar spinal cord had variable degrees of central chromatolysis, cytoplasmic vacuolation, and swelling, with displaced nuclei and occasional necrosis. Some of the sampled sciatic nerves had mild-to-intense axonal swelling and fragmentation. Microscopic lesions were absent in the two non-affected pigs. Pantothenic acid deficiency was presumptively diagnosed, and all newborn piglets were treated with a vitamin B complex. The condition did not re-appear after treatment. Insufficient pantothenic acid intake should be among the differential diagnoses of piglets with ataxia, muscle weakness and mortality. A fast diagnosis based on complete nervous system sampling is key to diagnose and counteract this condition.

Vertigo is a frequent emergency department (ED) presentation, yet the utility of non-contrast brain computed tomography (CT) in patients without focal neurological deficits remains uncertain. To assess the diagnostic yield of non-contrast brain CT in adult ED patients presenting with isolated vertigo and no focal neurological signs. A retrospective cross-sectional study was conducted at a tertiary ED in Riyadh, Saudi Arabia, from January 2021 to October 2024. Adult patients presenting with vertigo and a normal neurological exam who underwent non-contrast brain CT were included. Clinical and demographic data were analyzed to determine the prevalence and predictors of positive CT findings. Among 1,206 patients, only 43 (3.6%) had any positive CT findings. Most abnormalities were chronic or non-acute: space-occupying lesions (46.5%) and signs of idiopathic intracranial hypertension (39.5%). Acute pathology-defined as infarction or hemorrhage-was identified in just 6 cases (0.5%), all in patients with at least one cardiovascular risk factor. No acute findings occurred in patients without hypertension, diabetes, or dyslipidemia (n = 446; 0%). The diagnostic yield of non-contrast brain CT in isolated vertigo without focal deficits is extremely low, particularly in patients without vascular comorbidities. Imaging decisions should be guided by risk stratification, reserving CT for patients with cardiovascular risk factors or concerning clinical features. A selective imaging strategy may reduce unnecessary testing and optimize resource use without compromising patient safety.

Acute focal neurological deficits require rapid differentiation between ischemic stroke and stroke mimics to avoid treatment delays and inappropriate therapy. Seizures, including ictal deficits, status epilepticus, and post-ictal/Todd's phenomena, are among the most challenging mimics. This review summarizes the role of multimodal neuroimaging in distinguishing acute ischemic stroke from seizure-related deficits. We performed a focused narrative review of neuroimaging findings in acute stroke mimics, emphasizing non-contrast computed tomography (CT), CT angiography, CT perfusion, magnetic resonance imaging (MRI), including diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC), fluid attenuated inversion recovery (FLAIR), and arterial spin labeling (ASL) sequences. Imaging patterns, diagnostic pitfalls, and practical clues for hyperacute stroke pathways were synthesized. Acute ischemic stroke is typically suggested by vascular-territorial abnormalities, including arterial occlusion or stenosis, territorial hypoperfusion, and congruent DWI/ADC restriction. Seizure-related deficits more often show non-territorial cortical perfusion changes, ictal or status-related hyperperfusion, reversible MRI abnormalities, and absence of arterial occlusion. However, post-ictal hypoperfusion, peri-ictal diffusion restriction, and reperfusion-related hyperperfusion may overlap with ischemic patterns. A multimodal approach integrating vascular imaging, perfusion distribution, DWI/ADC, ASL, clinical timing, and EEG findings can improve diagnostic accuracy in the stroke-seizure differential without delaying treatment in true acute ischemic stroke.

ABSTRACTMale breast cancer is rare, accounting for less than 1% of all breast cancers, and central nervous system (CNS) metastases are an uncommon but poor prognostic manifestation. The aim of the current case report is to discuss a 50‐year‐old man with stage IV estrogen receptor–positive, progesterone receptor–positive, and HER2‐positive breast cancer who presented with new‐onset focal neurological deficits and was found to have a solitary left parietal brain metastasis with vasogenic edema and midline shift. He underwent gross total resection via craniotomy, with pathology confirming metastatic ductal carcinoma consistent with the primary tumor. Postoperatively, he received adjuvant stereotactic radiosurgery (30–35 Gy in five fractions) to the resection cavity and was transitioned from tamoxifen to trastuzumab deruxtecan (T‐DXd) for improved CNS‐directed systemic therapy. Surveillance imaging at 6 months demonstrated no intracranial recurrence, and systemic restaging showed no extracranial disease progression. This case highlights the importance of prompt neuroimaging for new neurological symptoms in male breast cancer patients and supports a multimodal strategy, including surgical resection, focal radiation, and CNS‐penetrant HER2‐targeted therapy, for achieving durable intracranial control in select patients with isolated brain metastasis.

7T-MRI enables detection of subtle hemorrhagic biomarkers associated with cerebral amyloid angiopathy (CAA). However, the relative performance of T2* compared with susceptibility-weighted imaging (SWI), as well as the applicability of Boston Criteria 2.0 at 7T, remains uncertain. This study evaluated diagnostic agreement between T2* and SWI, interobserver variability, and the utility of the Boston Criteria 2.0 at 7T-MRI and characterized the prevalence of emerging imaging biomarkers, such as the intragyral hemorrhage sign (IGHS). In this retrospective study, 130 examinations from 111 patients referred for 7T-MRI between 2022 and 2025 for transient focal neurologic deficits, cognitive impairment, suspected CAA, or Alzheimer's disease were analyzed. Two experienced neuroradiologists independently evaluated T2* and SWI sequences using ARIA-based categorical scoring for intracerebral parenchymal hemorrhage (IPH), cortical/subcortical microbleeds (C/SC-MB), deep microbleeds (D-MB), cortical superficial siderosis (cSS), and IGHS. Discrepancies were resolved by consensus. Boston Criteria 2.0 classifications were assigned by a vascular neurologist. Intersequence and interobserver agreement were assessed, and associations between imaging markers and Boston classifications were analyzed. Interobserver agreement of neuroradiologists was high across both sequences, with almost perfect agreement for IPH, C/SC-MB, D-MB, and cSS (κ = .85-1.00). T2* and SWI demonstrated almost perfect agreement for IPH, C/SC-MB, D-MB, and cSS (κ = .90-1.00) and substantial agreement for IGHS (κ = .62). Almost perfect agreement was observed between Boston scores based on SWI and T2* (κ = .92). IGHS was observed in about 24% and 41% cases with a positive Boston score with T2* and SWI, respectively. Among 81 patients with at least one hemorrhagic marker, 35 (45%) were excluded from CAA due to D-MBs detection despite radiologic features suggestive of CAA. T2* and SWI provide comparable diagnostic performance for CAA-related hemorrhagic markers and almost perfect agreement regarding the Boston Criteria at 7T. Interobserver agreement was high across all sequences, supporting the reproducibility of ARIA-based scoring at 7T. Boston Criteria 2.0 are applicable at 7T; however, improved detection of deep microbleeds may lead to false-negative classifications. Updated diagnostic frameworks tailored to 7T-MRI, including potential incorporation of IGHS, may be warranted.

Severe Plasmodium falciparum malaria remains a major cause of paediatric morbidity in sub-Saharan Africa. While mortality has declined in many settings, severe disease requiring escalation of care persists. Data on predictors of intensive care unit (ICU) transfer among children with severe malaria remain limited in Central Africa. This study aimed to describe the clinical and biological profiles of paediatric severe malaria in an urban Gabonese setting and to identify factors associated with ICU transfer as an early marker of clinical deterioration. A retrospective analytical study was conducted at the Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori (CHUMEFJE) in Libreville, Gabon. Medical records of children below 17 years and hospitalised between January 2021 and July 2022 with microscopically confirmed P. falciparum malaria were reviewed. Severe malaria was defined according to WHO 2014 criteria. ICU transfer among survivors was the primary adverse outcome. Clinical, laboratory, and demographic variables were analysed using univariate and multivariable logistic regression. A cumulative count of WHO severe malaria criteria was used as an indicator of disease severity. Among 3.009 hospitalised children, 480 (15.9%) met WHO criteria for severe malaria and were included. The median age was 6 [1-10] years. Overall mortality was low (0.7%), while 8.5% (n = 41) required ICU transfer. Neurological manifestations (64.2%) predominated, particularly prostration (49.2%), impaired consciousness (10.8), and coma (4.2%). ICU transfer was significantly associated with delayed consultation (p = 0.01) and neurological signs (p < 0.01). In multivariable analysis, impaired consciousness (aOR: 14.86; 95%IC [5.58-42.40], p < 0.01) and coma (aOR: 53.3; 95%IC [10.9-178.1], p < 0.01) remained the strongest independent predictors of ICU transfer, whereas isolated biological abnormalities such as severe anaemia or hyperparasitaemia were not. The risk of ICU transfer increased markedly with the number of concurrent severe malaria criteria, especially beyond three criteria (aOR: 10.59; 95%IC [2.38-42.87], p < 0.01). ICU transfer was frequent and primarily driven by neurological and accumulated severity features. Assessing the number of concurrent WHO criteria offers a pragmatic tool for risk stratification. Although conducted in a referral centre capturing the city's transmission heterogeneity, multicentre studies are needed to validate these predictors across diverse healthcare systems. Not applicable.

Our main goal was to describe the clinical, analytical, and neuroimaging characteristics of a large series of patients with migraine with aura (MA) as stroke mimic (SM). As secondary goals, we evaluated factors associated with perfusion computed tomography (PCT) alterations in MA. MA is a frequent SM in the acute setting. Increasing our knowledge and awareness of the clinical and radiological characteristics that may occur in the context of a MA as SM may improve diagnosis and reduce unnecessary treatments such as intravenous thrombolysis. We conducted a retrospective observational cross-sectional study including patients with a final diagnosis of MA who were evaluated at a tertiary hospital and stroke center under the stroke code (SC) protocol activation -focal neurological symptoms occurring within 24 h- between January 1, 2015, and January 31, 2025. Demographic variables (age, sex), clinical features (history of migraine, vascular risk factors, aura type), and biochemical markers (potassium, glucose, and creatinine levels) were collected. Moreover, we explored factors associated with PCT alterations in MA. Among 5513 SC, 68 (1%) were MA, with mean age of 42 (SD: 12.1) years old, 46/68 (68%) females. The most frequent aura symptom was sensory (67%). PCT alterations were found in 15/68 (22%), with a hypoperfusion pattern mainly unilateral, corresponding to a non-vascular territory. The RAPID automatic software was available in 9/15 (60%) patients. Of these, all patients showed Tmax > 4 s elevation, and one patient also presented Tmax > 6 s elevation. The automatic software analysis identified PCT alterations in five patients that did not show alterations in the qualitative analysis. Male sex (p = 0.003) and aphasic aura (p = 0.004) were associated with PCT alterations in patients with MA. MA as SM forms 1% of SC activation. Automatic RAPID software analysis may help identify PCT alterations that cannot be detected by qualitative analysis. Male sex and aphasia are associated with PCT alterations in MA, which may improve diagnosis in the acute setting.

Central nervous system (CNS) involvement in multidrug-resistant tuberculosis (MDR-TB) is associated with high morbidity, and evidence guiding the use of standardized all-oral regimens in intracranial disease is limited. We describe radiographic evolution of a presumed cerebellar tuberculoma during BPaLM-based therapy for MDR-TB. We report the clinical course, microbiologic data, treatment regimen, and serial neuroimaging of a man in his 30s with pulmonary MDR-TB, pleural involvement, and a small peripherally enhancing cerebellar lesion compatible with a tuberculoma. The patient presented with respiratory symptoms and mild headache, and was diagnosed with cavitary pulmonary tuberculosis, pleural involvement, and a small left cerebellar lesion. Further evaluation showed no ataxia, dizziness, or focal neurologic deficits. Sputum acid-fast culture was positive for Mycobacterium tuberculosis, and rapid molecular testing demonstrated rifampin resistance. Whole-genome sequencing confirmed resistance to rifampin, isoniazid, and ethambutol, and did not identify mutations associated with resistance to pyrazinamide, fluoroquinolones, linezolid, clofazimine, or bedaquiline. Treatment was transitioned to BPaLM (bedaquiline, pretomanid, linezolid, moxifloxacin) with adjunctive corticosteroids early in the course. Sputum cultures converted to negative approximately 6 weeks after treatment initiation. Serial brain MRI demonstrated progressive reduction in lesion size at 9 weeks, residual punctate enhancement at 21 weeks, near-complete resolution by 44 weeks, and complete radiographic resolution on subsequent imaging. The patient completed 52 weeks of therapy and remained clinically stable, without neurologic deficits or relapse more than 2 years after treatment completion. This case describes radiographic resolution of a small presumed cerebellar tuberculoma during extended BPaLM/BPaL-based therapy for disseminated MDR-TB, highlighting the evidence gap for standardized all-oral regimens in CNS drug-resistant tuberculosis.

Clade 2.3.4.4b H5Nx high pathogenicity avian influenza viruses (HPAIVs) have caused extensive mortality in wild birds, particularly colonial seabirds, since 2020. Among them, black-headed gulls (Chroicocephalus ridibundus) are abundant, synanthropic birds widely distributed across Europe and northern Asia that exploit diverse habitats, raising questions about their role in AIVs ecology. Recent field observations have reported post-HPAI ocular abnormalities in some marine birds, suggesting a potential contribution of the eye to disease expression. However, the nature of these changes, viral tissue distribution and the underlying pathogenesis remain unclear. To address this, 13 black-headed gulls from a cohort of 49 confirmed HPAI cases in France underwent clinico-pathological assessment, immunohistochemistry and molecular analysis. Affected birds commonly exhibited emaciation and central neurological signs. Histopathology and immunostaining revealed marked neurotropism and consistent involvement of intraocular structures, including anterior uveitis and retinal degeneration. Viral antigen was detected in neuronal tissue, visceral and integumentary epithelial cells, with no evidence of endotheliotropism. This pattern resembles that reported in domestic ducks and may influence viral diffusion, persistence, intra- and interspecific transmissions. Our results suggest the eye is an underestimated target organ in HPAI infection, and provide new insights into the pathogenesis of HPAI-induced ocular abnormalities in seabirds.

Institutional Variation in Cervical Spine Imaging among Children with Blunt Trauma: A Multicenter Prospective Observational Cohort Study.

Hemilaminectomy is the most common surgical procedure for type I thoracolumbar intervertebral disk herniation (TL-IVDH). Despite the clinical relevance of postoperative morphological assessment to predict postoperative complications, only a few studies have evaluated long-term changes at the surgical site, such as those affecting the spinal cord and vertebrae, after hemilaminectomy for type I TL-IVDH. This retrospective study describes postoperative changes at the surgical site, including disk height, in dogs that had undergone hemilaminectomy and subsequently experienced late recurrence. 19 dogs were eligible for inclusion in this study. The disk height index (DHI) at the initial affected site was significantly reduced compared to the time of initial onset. The maximal spinal cord compression rate at the initial affected site at the time of recurrence decreased significantly compared to that at the time of initial onset. Two dogs had bone regrowth at the site of first surgery at the time of recurrence. No recurrence of disk herniation or spinal cord injurycaused by bone regrowth was observed at the surgical site. In conclusion, structural changes such as decreased DHI and bone regrowth were observed at the surgical site a long time after hemilaminectomy, but these changes were not the direct cause of the neurologic signs observed at recurrence.