Plausible Cause Research Articles

Abstract 4125528: Interleukin-6-Modulated Inflammation Augments Deep Vein Thrombosis Organization in Mice

Background: A disorganized thrombus jeopardizes its stability, leading to an augmented risk of fatal acute complications following deep vein thrombosis (DVT). One of its plausible causes is impaired immune cell responses. While the importance of the cytokine interleukin-6 (IL-6) in immune responses is well established, its action towards DVT organization is poorly elucidated. Accordingly, we aimed to investigate the role of IL-6 in the acute immunoinflammatory orchestration of DVT organization in vivo. Methods and Results: We performed total ligation of the infrarenal inferior vena cava (IVC) in 8–12-week-old male C57BL/6J mice a day after starting continuous, subcutaneous mini-osmotic pump infusion of recombinant IL-6 (rIL-6; 1.2 µg/day, n = 21) or vehicle (n = 21), after which DVT pathology was examined. Exogenous IL-6 administration significantly decreased DVT mass at day 2 (16.6±1.9 vs. 23.0±0.9 mg/cm; p<0.01) and day 4 (16.2±1.6 vs. 21.4±0.8 mg/cm; p<0.05) compared to vehicle-treated mice. Intriguingly, rIL-6-treated mice’s DVT exhibited distal tropism of a macroscopically white lesion with abundant neutrophils and platelet accumulation, indicating enhanced DVT organization (Figures A–B). Quantitative polymerase chain reaction (qPCR) analysis revealed the distal edge upregulation of leukocyte chemoattractants, leukocyte-platelet interaction markers, and extracellular matrix regulator genes, confirming that the IL-6-driven inflammatory response was linked to augmented DVT organization. Spatiotemporally, real-time intravital imaging on stasis- and irradiation-induced saphenous vein thrombosis among intraperitoneal rIL-6 (0.3 µg/mouse)-treated mice demonstrated marked acute leukocyte and platelet recruitment with subsequent aggregation to the distal edge of the thrombus (Figures C–D), which consequently yielded an enhanced thrombus resolution at the distal edge. Conclusions: Our findings suggest that IL-6-driven inflammation results in distal tropism of leukocyte-platelet infiltration, which is important for modulating thrombus organization and subsequent DVT amelioration. This study presents a novel insight into the immunothrombosis process, with potential clinical implications for DVT.

Present simple forms in the written work of Bangladeshi EFL learners

This paper presents an investigation on plausible causes of similarities and differences of present simple tense features in the written work of Bangladeshi EFL learners. It endeavours to compare between British Standard English (BSE) present simple tense features found in different standard sources and the same used by the Bangladeshi EFL learners. In doing so, content analysis is employed on written compositions of a specific topic and these are collected from 30 postgraduate advance level Bangladeshi EFL learners with a special focus on the use of present simple form. Atlas.ti software is used to analyse the collected data. It is found that the features of present simple tense are the mostly used form and also a complex part of the learner’s written work. The study has found that one of the major causes of similarities and dissimilarities between the two standards are the cross-linguistic influence (CLI). This influence may be a ‘positive transfer’ that refers to the facilitating effects of one language in acquiring another; or a ‘negative transfer’ i.e. the divergences due to some differences between the target language and the native one of the learners (Odlin, 2013). For the similar features between the Bangladeshi native language, Bengali (L1) and English present tense, the learners can easily adopt the features; contrarily, they make occasional mistakes in writing or do not use in the cases of dissimilar features. Thus, based on current CLI and second language acquisition (SLA) theories, the study has hopefully contributed to the theoretical development of cross-linguistic study in written English in Bangladesh.

Failure of neuromuscular blockade despite high doses of rocuronium and atracurium in a patient with colorectal carcinoma

Resistance to the effects of rocuronium and other neuromuscular blocking agents (NMBA) has been previously reported, including delayed onset of relaxation, rapid recovery and incomplete paralysis under recommended doses. These conditions have been associated with denervation injury, burns, immobilisation, infections, metabolic disorders, and drug interactions. In this report, we describe the case of a young male without any known pre-disposing factor for NMBA resistance, who failed to attain muscle relaxation with non-depolarising NMBA despite high doses of rocuronium and atracurium during two surgeries for colorectal cancer, several months apart. Investigations for drug failure and genetic testing did not indicate a plausible cause. After chemotherapy and tumour resection, the patient underwent a third surgical procedure under general anaesthesia with normalised NMBA response. Patient's written consent was obtained for publication.

Comprehensive Assessment of Deep-Water Vessel Implosion Mechanisms: OceanGate's Titan Submersible Failure Sequence Explained

This study outlines the physical mechanisms involved in a submersible implosion and analyzes the loss of the Titan submersible (‘sub’) that occurred on 18 June 2023 during a mission to visit the wreck of the Titanic. Titan’s collapse mechanisms at the moment of implosion are described in detail and outer hull fracturing rate, subsequent implosion rate, accompanying heat release and other key processes are quantified. Plausible causes of the hull’s leak leading up to critical loss of the sub's hermetic closure are reviewed using test results made publicly available by the U.S. Marine Board of Investigation. Their data indicated that the bond interfaces between the individual layers of the carbon fiber hull (Hull V2) were critically compromised due to manufacturing defects, voids, porosity, and inadequate adhesive integrity, resulting in significant delamination. Analysis of data from the real-time hull health monitoring system, revealed acoustic anomalies and strain shifts, pointing toward increasing structural fatigue, which went unaddressed prior to the fatal dive. The implosion process can be characterized by an instantaneous collapse of the air volume within the hull under extreme external pressure: even the tiniest leak would lead to destruction of the vessel's structural integrity. The destruction was the more devastating, because it was accompanied by a secondary explosion due to the heat exchange between the collapsing air volume and the ambient sea water. While the collapsing air was phase-changed into a supercritical state, the generated heat caused the adjacent seawater to evaporate and expand. Hull pieces fragmented by the initial implosion were strewn around during the secondary explosion phase, which ceased rapidly as the steam condensed back into seawater once again. The Titan incident underscores the urgent need for improved design standards, rigorous quality control in manufacturing, and enhanced real-time monitoring to prevent similar failures of future deep-sea exploration vehicles.

A Millimeter Rebrightening in GRB 210702A

We present X-ray to radio frequency observations of the bright long gamma-ray burst GRB 210702A. Our Atacama Large Millimeter/submillimeter Array 97.5 GHz observations show a significant rebrightening by a factor of ≈2 beginning at 8.2 days post-burst and rising to peak brightness at 18.1 days before declining again. This is the first such rebrightening seen in a millimeter afterglow light curve. A standard forward shock model in a stellar wind circumburst medium can explain most of our X-ray, optical, and millimeter observations prior to the rebrightening, but significantly overpredicts the self-absorbed radio emission, and cannot explain the millimeter rebrightening. We investigate possible explanations for the millimeter rebrightening, and find that energy injection or a reverse shock from a late-time shell collision are plausible causes. Similar to other bursts, our radio data may require alternative scenarios such as a thermal electron population or a structured jet to explain the data. Our observations demonstrate that millimeter light curves can exhibit some of the rich features more commonly seen in optical and X-ray afterglow light curves, motivating further millimeter wavelength studies of GRB afterglows.

Quantitative Analysis of the Sloping Terrain on Al-Biruni’s Floor and Implications for the Cratering Process

Surface unloading due to impact cratering results in lava filling the crater floor. Elevation differences in the crater floor, a common geological phenomenon on the Moon, represent direct evidence of cratering processes. However, few studies have been conducted on mare-filled craters on the Moon. Al-Biruni (81 km) is a farside impact crater with an inclined topographic profile on its floor. We quantitatively measure the morphology of Al-Biruni and model the basaltic lava emplacement to depict the cratering process. Differential subsidence due to melt cooling, wall collapse, impact conditions and structural failure were assessed as potential factors influencing the formation of the elevation differences on the floor. The results suggest that pre-impact topography is a plausible cause of the differences in floor elevation within Al-Biruni. Other factors may also play a role in this process, affecting lava flow by altering the topography of the crater floor after the impact. Thus, regardless of whether the lava inside the crater is impact-generated or comes from outside the crater, altering topography at different stages of the cratering process is an essential factor in creating the sloped terrain on the crater floor.

A skeletal dysplasia leading to a perinatal death in 17th–19th century Lisbon, Portugal

AbstractCongenital skeletal disorders are a heterogeneous group of anomalies that become evident during gestation. They are expressed in the shape and growth of the bones during development because of a defective genetic background. With the follow‐up of pregnant women and the advances in prenatal ultrasonographic examination and molecular genetic tests, nowadays, congenital skeletal disorders are identified at an early gestational age. If they are considered lethal, the termination of pregnancy is advised. This work unveils an exceptional instance of a rare pathological condition identified in a perinate (birth ± 2 weeks) from the 17th to 19th centuries, recovered during an excavation at the cloister of the São Domingos Convent in Lisbon, Portugal. The skeleton presents with exuberant modifications that include, among others, severe shortening (micromelia) and bowing of the long bones of the upper and lower limbs. The main skeletal findings indicated a presumptive general diagnosis of skeletal dysplasia, while the differential diagnosis includes hypophosphatasia, campomelic dysplasia, achondrogenesis, thanatophoric dysplasia, and severe achondroplasia with developmental delay and acanthosis nigricans (SADDAN) as the most plausible causes for the observed skeletal changes. Even though an exact diagnosis is unattainable based only on the macroscopic analysis of the bones, the phenotypic features observed in this perinate are more consistent with thanatophoric dysplasia type 1.

A risk evaluation method for human-machine interaction in emergencies based on multiple mental models-driven situation assessment

In the process of human-machine interaction (HMI) under abnormal situations, situation assessment (SAS) is a critical component as incorrect SAS can feed into inappropriate actions and cause severe accidents. Therefore, it is essential to model SAS for HMI risk evaluation. During emergency situations, SAS is predominantly affected by time pressure. However, current researches focus on deliberative SAS with sufficient time and have limitations in quantifying the time pressure effect on SAS during emergencies. This paper proposes a risk evaluation method for HMI in emergencies by quantitatively modeling the time pressure effect on SAS under the recognition-primed decision (RPD) model framework. Firstly, SAS process is characterized as identifying the first plausible cause of an abnormal phenomenon driven by multiple Bayesian network-based mental models, and a simulation algorithm for SAS process is proposed to evaluate HMI risk. Secondly, two effects of time pressure on SAS activities, i.e., filtration effect on information perception and impair effect on knowledge retrieval, are quantified based on the Saliency-Effort-Expectancy-Value (SEEV) model and the Adaptive Control of Thought-Rational (ACT-R) theory. Finally, this method is applied to a Boeing 737-31S accident with high time pressure and results demonstrate the effectiveness of the method.

The influence of social, demographic and economic factors on fertility trends in Gulf Cooperation Council countries: A longitudinal time trend analysis-1980-2021.

To analyze the fertility rate trends in the GCC countries and their association with socioeconomic factors so that policymakers may use the study findings for future healthcare plans. Total population, crude death rate, life expectancy, literacy rate, human development index (HDI), female employment, unemployment rate, urbanisation, gross domestic product (GDP) per capita and inflation were chosen as possible predictors of TFR trends. The data were collected for the Global Burden of Disease 2021 study and other official databases such as the World Bank, the United Nations Development Program and Our World in Data for the 6 Gulf Cooperation Council (GCC) countries. Mean with standard deviation and percentage change was calculated to assess trends of TFR and all other variables from 1980-2021. The fertility rate declined in all 6 countries in 2021 compared to 1980. The highest decline was found in the United Arab Emirates (75.5%), while the lowest was in Kuwait (60.9%). From 1980-2021, total population, life expectancy, HDI, literacy rate, GDP, urbanisation, and female labor force increased in all GCC countries. The total population, life expectancy, urbanisation, female labor force, GDP and HDI were negatively and significantly correlated with TFR (p<0.01). The literacy rate showed a negative and significant correlation with TFR in Bahrain, Kuwait, Saudi Arabia, and Qatar. The TFR is declining in GCC countries. The plausible causes include the inclination towards postponement of marriages and excessive costs of living. These trends and associations need to be evaluated by policymakers so that they identify priority areas for interventions, allocate resources and formulate developmental plans accordingly to ensure strategic progress of the region.

Novel Coronavirus: An Overview of the History, Pathophysiology, Diagnosis, and Management of the Pandemic COVID-19 Catastrophe, with Special Emphasis on Herbal Treatment Alternatives

Abstract: The crisis of COVID-19 pandemic, has shaken up the whole world with its power of transmission and unknown treatment strategy. A disease that starts with fever, cold, and cough leads to extreme fatigue, loss in breathing capacity, alveolar damage, and eventual death. The disease forced human beings to stay at home to protect humankind. Due to the serious nature of this COVID- 19 pandemic, humankind was forced to understand the plausible cause and methods to reduce the spread and find out the best possible therapeutic regimen. Thus, the present review provided new insight into the history, symptoms, pathogenesis, diagnosis, clinical research, and follow-up treatment strategies of COVID-19. Further, In order to deal with such a pandemic situation, we have even introduced a novel concept of natural therapy based on medicinal plants for repurposing it as potential as a therapeutic warrior against COVID-19.

Mechanistic Investigation on the Antibacterial Activity of Biogenic Silver Nanoparticles Prepared Using Root Extract of Sarsaparilla and Demonstrated their In Vivo Efficacy in Zebrafish Model.

Antibiotic success rates are decreasing as drug-resistant bacteria become more prevalent, prompting the development of new therapeutic drugs. Herein, we demonstrated the antimicrobial activity of sarsaparilla root extract fabricated silver nanoparticles (sAgNPs). The UV-Visible spectra revealed that the surface Plasmon resonance maxima of sAgNPs were at 415nm. Transmission electron microscopy confirms that the particles are spherical with size of 12-35nm. The minimum inhibitory concentration (MIC) of sAgNPs against Escherichia coli, uropathogenic Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecalis, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus was 62.5, 62.5, 62.5, 62.5, 125 and 125µM, respectively. At 1X MIC, sAgNPs induces excess reactive oxygen species (ROS) production and disturbs the bacteria membrane intergity, causing cytoplamic membrane depolarization. Interestingly, antibacterial activity of sAgNPs was considerably reduced in the presence of an antioxidant, N-acetyl cysteine, suggesting that ROS-induced membrane damage is a plausible cause of cell death. In contrast to many studies that only report the in vitro activity of NPs, we determined the in vivo antibacterial efficacy using the zebrafish model. It was found that sAgNPs protect fish from infection by inhibiting bacterial growth and eliminating them from the fish. In addition, the catalytic potential of sAgNPs for wastewater decontamination was demonstrated by degrading organic pollutants such as methyl orange, congo red, reactive black, and acid blue. The pollutants degraded in less than 10min, and the reaction follows pseudo-first-order kinetics. As a proof of concept, the catalytic potential of sAgNPs in degrading mixed dyes to satisfy industrial wastewater treatment needs was established. In summary, sAgNPs have the potential to act as nanocatalysts and nano-drugs, addressing key challenges in medical and environmental research.

Improved resilience and proteostasis mediate longevity upon DAF-2 degradation in old age

Little is known about the possibility of reversing age-related biological changes when they have already occurred. To explore this, we have characterized the effects of reducing insulin/IGF-1 signaling (IIS) during old age. Reduction of IIS throughout life slows age-related decline in diverse species, most strikingly in the nematode Caenorhabditis elegans. Here we show that even at advanced ages, auxin-induced degradation of DAF-2 in single tissues, including neurons and the intestine, is still able to markedly increase C. elegans lifespan. We describe how reversibility varies among senescent changes. While senescent pathologies that develop in mid-life were not reversed, there was a rejuvenation of the proteostasis network, manifesting as a restoration of the capacity to eliminate otherwise intractable protein aggregates that accumulate with age. Moreover, resistance to several stressors was restored. These results support several new conclusions. (1) Loss of resilience is not solely a consequence of pathologies that develop in earlier life. (2) Restoration of proteostasis and resilience by inhibiting IIS is a plausible cause of the increase in lifespan. And (3), most interestingly, some aspects of the age-related transition from resilience to frailty can be reversed to a certain extent. This raises the possibility that the effect of IIS and related pathways on resilience and frailty during aging in higher animals might possess some degree of reversibility.

Epidemioclinical and Therapeutic Aspects of Malnutrition at Pediatrics Department of Mali Hospital

Severe acute malnutrition still constitutes a worrying public health problem today. In its complicated form, it remains a significant cause of infant mortality in our countries. Objective: To study the epidemiological-clinical and therapeutic aspects of Severe Acute Malnutrition (SAM) complicated by anemia. Methodology: This is a retrospective descriptive study from 2019-2020 and prospective 2021 which took place at the Mali hospital. The study focused on all children aged 6 to 59 months hospitalized for severe acute malnutrition complicated by anemia. The Results: From January 1, 2019 to December 31, 2021, we screened 5,676 children among whom 200 children were diagnosed with SAM complicated by anemia with a hospital frequency of 3.52%. Children under 5 years old were the most represented with 85.5% of cases. There was no predominance of sex, the ratio =1. In our study, marasmus was the majority with a rate of 88.5% followed by kwashiorkor 7% and the mixed form 4.5%. The main complications observed were dehydration, fever, severe anemia and hypoglycemia with respective rates of 27%, 16%, 13.5% and 9.5%. The patient profile had hypochromic microcytic anemia with a number of 167 or 83.5% most often linked to iron deficiency. Gastroenteritis, pneumonia, malaria, and cerebral palsy were the most frequent associated pathologies during our study with respective rates of 48.5%, 34%, 26% and 12.5%. Conclusion: At the end of our study at the Mali hospital where the investigation took place, we managed to conclude that children aged 6 to 59 months who were screened for severe acute malnutrition had severe anemia with a rate of 13.5% microcytic type to 83.5% which explains that iron deficiency was the most plausible cause and 57% of these children screened had pallor.

Amino acid transporters in neurological disorders and neuroprotective effects of cysteine derivatives

For most diseases and disorders occurring in the brain, the full causes behind them are yet unknown, but many show signs of dysfunction of amino acid transporters or abnormalities in amino acid metabolism. The blood-brain barrier (BBB) plays a key role in supporting the function of the central nervous system (CNS). Because of its unique structure, the BBB can maintain the optimal environment for CNS by controlling the passage of hydrophilic molecules from blood to the brain. Nutrients, such as amino acids, can cross the BBB via specific transporters. Many amino acids are essential for CNS function, and dysfunction of these amino acid transporters can lead to abnormalities in amino acid levels. This has been linked to causes behind certain genetic brain diseases, such as schizophrenia, autism spectrum disorder, and Huntington's disease (HD). One example of crucial amino acids is L-Cys, the rate-limiting factor in the biosynthesis of an important antioxidant, glutathione (GSH). Deficiency of L-Cys and GSH has been linked to oxidative stress and has been shown as a plausible cause behind certain CNS diseases, like schizophrenia and HD. This review presents the current status of potential L-Cys therapies and gives future directions that can be taken to improve amino acid transportation related to distinct CNS diseases.

Horizon scan survey to identify key research questions to promote sustainability of the marine recreational fishery in Namibia

Horizon scan survey to identify key research questions to promote sustainability of the marine recreational fishery in Namibia

Long-lasting severe anemia following treatment with natalizumab for relapsing–remitting multiple sclerosis: a case report

BackgroundNatalizumab is a monoclonal antibody used to treat patients with relapsing–remitting multiple sclerosis. Anemia is a recognized side effect, but it is usually mild and of a short duration when natalizumab is stopped. Here, we describe a case of a young woman with severe and especially long lasting anemia associated with treatment with natalizumab, persisting up to a year after treatment was stopped.Case presentationA 24 year-old Caucasian woman with relapsing–remitting multiple sclerosis developed severe transfusion dependent anemia after 27 infusions with natalizumab, which was her first and only treatment for her multiple sclerosis. Extensive hematologic diagnostics did not reveal any malignant cause or any other plausible non-malignant cause for her anemia. The bone marrow was found to be hypercellular, with a maturation arrest of the erythropoiesis and with grade 1–2 fibrosis. No specific treatment for the anemia was given. The hemoglobin level showed signs of spontaneous increase after nearly one year after natalizumab was discontinued.ConclusionSevere anemia can be caused by treatment with natalizumab. This case adds information to the few other similar reported cases, demonstrating the potential duration of the anemia, as well as detailed description of hematologic findings. The mechanism is most likely due to inhibition of α4 subunit of the α4β1-integrin, which is present on both lymphocytes and erythroid precursor cells.

Cerebral Anoxia in an 18-year-old Patient Being Treated for Major Depressive Disorder: How Forensic Detective Work Uses Medical Knowledge Including Clinical Pharmacology to Solve Cases.

This column is the first of a 3-part series illustrating the importance of medical knowledge, including clinical pharmacology, in a forensic context. This first case involved an 18-year-old high school student who suffered an anoxic brain injury and remained in a state of permanent decorticate posture, unresponsive except for grunts and primitive movements until he died several years later. Our investigation began by ruling out plausible causes that were suggested by the defense in the malpractice suit. Once those possibilities were eliminated, the focus was on what accounted for the damage to the patient using general medical knowledge and clinical pharmacology. The 4 Ds of forensic psychiatry (duty, damages, dereliction, and direct cause) are the 4 elements that the plaintiff is required to prove in civil court to prevail in a malpractice suit and are applied to this case with a special focus on dereliction and direct cause. This catastrophic outcome was due to 3 factors. First, the patient had physiologically significant dehydration to the point that he had developed a reflex tachycardia to maintain his blood pressure. Second, the patient had been switched from extended to immediate-release quetiapine, resulting in a doubling of the peak concentration of the drug, which produced higher occupancy of alpha-1 adrenergic, histamine-1, and dopamine-2 receptors, causing a further drop in his blood pressure as well as increased sedation and impairment of his gag reflex. These effects occurred quickly because of the faster absorption of the IR formulation of the drug. Third, the patient had gone to sleep in a reclining chair so that his brain was above his heart and his lower extremities were below his heart, resulting in an increased "steal" of cardiac output going to his brain. These 3 factors together led the patient to aspirate and suffer a hypoxic brain injury after an episode of vomitus. This column explains the process by which the cause of this sad outcome was determined, how it was related to a dereliction of duty to the patient, and how other proposed causes were ruled out.

DESCRIBING THE LOCATION AND MORPHOLOGY OF THE DOTS IN WHITE DOT FOVEA USING ADAPTIVE OPTICS.

To characterize the white dots in white dot fovea, an entity chiefly described in Japan, using adaptive optics imaging and propose a hypothesis regarding their origin. The patient underwent comprehensive ophthalmic examination, including color and green monochromatic fundus photography, fluorescein angiography, spectral-domain optical coherence tomography, and adaptive optics imaging. An asymptomatic 66-year-old Korean woman presented with bilateral white, glistening deposits in a ring pattern around the fovea of both eyes. The dots were highly reflective on green monochromatic images, were not visible on fluorescein angiography, and appeared hyperreflective in the inner retina using spectral-domain optical coherence tomography. Adaptive optics showed polygonal granules ranging from 1 to 10 μ m in size. The patient denied any systemic disorder or the use of any medications related to crystalline retinopathy. The patient had lived in Japan for 35 years before just moving to the United States. The location, small size, and polygonal shape of the dots in white dot fovea are suggestive of intraretinal deposition of crystals, and not cells on the surface of the fovea as has been previously proposed. Carotenoid deposition related to dietary habits is a plausible cause because of the similarity to other retinopathies associated to these compounds.

Interdependence of placenta and fetal cardiac development.

The placenta and fetal heart undergo development concurrently during early pregnancy, and, while human studies have reported associations between placental abnormalities and congenital heart disease (CHD), the nature of this relationship remains incompletely understood. Evidence from animal studies suggests a plausible cause and effect connection between placental abnormalities and fetal CHD. Biomechanical models demonstrate the influence of mechanical forces on cardiac development, whereas genetic models highlight the role of confined placental mutations that can cause some forms of CHD. Similar definitive studies in humans are lacking; however, placental pathologies such as maternal and fetal vascular malperfusion and chronic deciduitis are frequently observed in pregnancies complicated by CHD. Moreover, maternal conditions such as diabetes and pre-eclampsia, which affect placental function, are associated with increased risk of CHD in offspring. Bridging the gap between animal models and human studies is crucial to understanding how placental abnormalities may contribute to human fetal CHD. The next steps will require new methodologies and multidisciplinary approaches combining innovative imaging modalities, comprehensive genomic testing, and histopathology. These studies may eventually lead to preventative strategies for some forms of CHD by targeting placental influences on fetal heart development.

Approaching an undetermined diagnosis in the aftermath of rhombencephalitis: A case report

A 49-year-old male patient manifested acute onset increased imbalance, quadriparesis, and speech impairment 1 month after undergoing ventricular-peritoneal shunt for normal pressure hydrocephalus (although magnetic resonance imaging [MRI] of the brain with contrast was otherwise normal), which showed improvement afterward. He had hypercalcemia and elevated erythrocyte sedimentation rate. Repeat brain MRI revealed pachymeningitis coupled with rhombencephalitis, while cerebrospinal fluid study unveiled only increased protein level without evidence of active infection. Given these findings, neurosarcoidosis was preliminarily considered a plausible cause of the recent clinical manifestations, and the patient was prescribed methylprednisolone, which led to significant improvement. However, the steroid treatment was discontinued on the revelation that the patient grappled with severe sepsis. Despite an initial improvement following a post-management of sepsis, his condition deteriorated, and he became lost to follow-up after 4 months of initial presentation. An infective etiology was ruled out since his condition improved with steroid. Precluding vasculitis or demyelinating disorder left the physicians with primary central nervous system (CNS) lymphoma or sarcoidosis as a proper diagnosis based on the fact that the patient experienced deterioration when steroid was excluded from the treatment regimen. This case study portrays a need to conduct a more specific and elaborate investigation, driven by a strong perception to both primary CNS lymphoma and sarcoidosis, to optimize clinical diagnosis, which facilitates the formulation of an appropriate treatment regimen.