There have been 26 cases of surgically resected intradural extramedullary cavernomas in the lumbar nerve root. Only 4 cases were accompanied by intratumoral hemorrhage. A 63-year-old woman presented with right lower limb paresthesia that had begun 14 and 6 months ago, followed by gradually worsening motor paralysis over the last 2 months. Magnetic resonance imaging revealed a homogeneous intradural extramedullary lesion with niveau at the L4 level. The affected L4 nerve root on the right had thinned and was strongly adherent to the surrounding gliosis plane due to repeated hemorrhage. Therefore, we had no choice but to sacrifice the nerve root, which was thought to be the origin of the tumor. Consequently, total tumor resection was performed. The pathological diagnosis was cavernoma. This is the fifth hemorrhagic case of a cavernoma originating from the lumbar nerve root. Although intradural extramedullary cavernomas in the lumbar nerve roots are rare, they can present with hemorrhage. It should be considered in the differential diagnosis when radiographic imaging shows findings suggestive of niveau.

Neuroinfectious cerebral vasculitis is a rare but potentially underrecognized cause of ischemic stroke. Its clinical and neuroimaging features may closely mimic those of common cerebrovascular disorders, posing a diagnostic challenge. We describe two patients who presented with ischemic stroke, one with an atypical presentation and the other with recurrent episodes, in whom advanced neuroimaging and cerebrospinal fluid (CSF) analysis were pivotal in establishing the diagnosis. A 55-year-old man presented with a two-month history of nonfocal symptoms and was found to have a right posterior cerebral artery infarct with multifocal intracranial stenoses. Syphilis serology was positive in both blood and CSF. High-resolution magnetic resonance vessel wall imaging (HR-VWI) demonstrated multifocal vessel irregularities suggestive of inflammatory vasculopathy, although the initial clinical suspicion was ischemic stroke. A 48-year-old woman presented with recurrent posterior circulation strokes and progressively worsening neurological symptoms. HR-VWI again revealed vessel irregularities, prompting further investigation with CSF analysis, which identified herpes simplex virus 2 (HSV-2). These cases highlight the importance of considering neuroinfectious etiologies in patients presenting with unexplained, multifocal, or recurrent ischemic strokes. Advanced neuroimaging techniques, such as HR-VWI, may help identify intracranial vasculitic changes and prompt further targeted investigations, including CSF analysis, which is essential for establishing a neuroinfectious diagnosis. Given the potentially treatable nature of these conditions, early recognition and initiation of pathogen-specific therapy, supported by a multidisciplinary approach, are essential to optimizing clinical outcomes.

A 35-year-old man presented with bilateral visual disturbance and was newly diagnosed with HIV infection. Initial evaluation revealed positive syphilis serology with a VDRL titer of 1:4, and ophthalmologic examination demonstrated bilateral optic disc swelling. Cerebrospinal fluid analysis showed no definitive evidence of neurosyphilis. The patient was treated with intravenous ceftriaxone, achieving both clinical improvement and serologic response. Six months later, he presented with recurrent, unilateral visual symptoms. Subsequent evaluation revealed a fourfold increase in VDRL titer and findings consistent with neuroretinitis. A diagnosis of recurrent ocular syphilis was established, and the patient was treated with intravenous penicillin G, resulting in clinical recovery. No recurrence was observed during a three-year followup period. This case highlights that ocular syphilis may recur despite adequate initial clinical and serologic response in individuals with HIV infection, underscoring the importance of close serologic monitoring and long-term ophthalmologic follow-up.

The ability to create experiences which misrepresent reality and thereby meet strategic goals is a stable trait that varies substantially in the general population. The capacity for such phenomenological control can be measured by response to imaginative suggestions for a variety of experiences, e.g. hallucination in various modalities, amnesia, paralysis, or motor actions, which are experienced as involuntary. Here, we present norms for a German translation of the Phenomenological Control Scale [Lush et al. (The Phenomenological Control Scale: measuring the capacity for creating illusory nonvolition, hallucination, and delusion. Collabra: Psychology 2021;7:29542)]. Data were collected from a representative sample of native-German speakers (N = 299) using a single-session online screening procedure. We show that the translated scale is psychometrically sound, and in line with the results of the original scale in terms of mean scores, distribution, and internal consistency. All analyses, code, data, materials, and the full questionnaire script are made freely available. Other researchers in the field of psychology are welcome to access and encouraged to use the German norms for the Phenomenological Control Scale, e.g. to assess the degree to which trait phenomenological control may be involved in other psychological effects.

Background Regional anesthesia (RA) offers established perioperative benefits, yet many patients choose general anesthesia (GA) even when RA is a clinically appropriate option. Understanding patients' specific concerns and other factors associated with anesthetic preference may help improve patient-centered preoperative communication and shared decision-making. Methods This cross-sectional, questionnaire-based study included 276 adult patients scheduled for elective surgery at a public general hospital in Greece. Before preoperative anesthetic consultation, participants reported their anesthetic preference, previous RA experience, and sociodemographic and clinical characteristics. Patients who preferred GA identified their concerns regarding RA from 11 predefined items. Factors independently associated with anesthetic preference were assessed using multivariable binary logistic regression. Results Of 350 eligible patients invited, 276 completed the survey (response rate = 78.9%); 65.9% (n = 182) preferred GA and 34.1% (n = 94) preferred RA. Male sex (odds ratio {OR} = 7.12; 95% confidence interval {CI}: 3.13-16.22; p < 0.001) and previous RA experience (OR = 3.50; 95% CI: 1.70-7.19; p = 0.001) were independently associated with RA preference. Surgical specialty, education, and employment status were also independently associated with anesthetic preference. Among patients preferring GA (n = 182), the most frequently reported concerns were hearing events during surgery (90.1%, n = 164), seeing the procedure (77.5%, n = 141), and experiencing intraoperative pain (73.1%, n = 133). Concerns about permanent paralysis (40.7%, n = 74) and back injury (40.1%, n = 73) were less frequent. Among respondents to the information-related items (n = 202), 31.2% (n = 63) reported having heard that RA could cause complications, most commonly from relatives (66.7%, n = 42), while 95.5% (n = 193) wanted their anesthesiologist to address their questions about RA. Conclusions GA was preferred by approximately two-thirds of elective surgical patients despite RA being a clinically viable option. The leading concerns regarding RA centered on the awareness of the surgical environment and intraoperative pain rather than rare neurological complications. Anesthetic preference was also independently associated with previous RA experience and several patient characteristics. Identifying and directly addressing these concerns during preoperative counseling may support more informed and individualized anesthetic decision-making.

Syphilis remains a major global public health concern due to the sustained increase in incidence observed over recent decades, particularly among high-risk populations. Its broad clinical spectrum and ability to mimic numerous dermatological and systemic diseases continue to make it a relevant diagnostic challenge in dermatological practice. This review summarizes the main epidemiological, microbiological, clinical, diagnostic, and therapeutic aspects of Treponema pallidum infection, with special emphasis on mucocutaneous manifestations and recent advances in molecular diagnostic techniques. Current therapeutic strategies, clinical and serological follow-up, and special situations such as neurosyphilis, ocular syphilis, pregnancy, and HIV infection are also reviewed. Finally, emerging preventive challenges are discussed, including doxycycline post-exposure prophylaxis (DoxyPEP), antimicrobial resistance, and future perspectives in vaccine development.

The objective of this study was to review pupillary and ocular sensory signs historically associated with neurosyphilis, focusing on eponymous findings because they are the most traceable and consistently cited descriptors in the historical neuro-ophthalmic literature. These signs were originally described between 1850 and 1910 by five clinicians whose observations later received eponymous recognition. This study was designed as a narrative historical review supported by a structured search to ensure completeness. Only eponymous signs with established and consistent usage in the medical literature were included; purely descriptive or ambiguous terms were excluded. Searches were conducted and last updated on January 1, 2026, using PubMed/MEDLINE, Google Scholar, and major digitized archives (Gallica, HathiTrust, Internet Archive, and the Wellcome Collection). Search strategies in English, German, and French combined syphilis-related terms with the names of the relevant clinicians (Baillarger, Berger, Gowers, Haenel, and Saenger). Two reviewers independently screened the sources and extracted data on the eponym, year of description, primary reference, clinical features, and biographical background. Disagreements were resolved by consensus. Three signs involved characteristic pupillary abnormalities: unilateral mydriasis (Baillarger sign), an oval or elliptical pupil (Berger sign), and absent light reaction with a sluggish near response (Saenger sign). Two additional signs reflected sensory or autonomic involvement: diminished deep ocular sensation to digital pressure on the globe (Haenel sign) and non-specific pupillary oscillation (hippus) described by Gowers. Taken together, these findings show how clinicians attempted to localize autonomic and sensory deficits in neurosyphilis in the era before serologic testing. Although current diagnosis depends largely on serologic testing, neuroimaging, and established treatment protocols, knowledge of these historical neuro-ophthalmic signs remains clinically relevant. They can assist in identifying atypical or delayed cases and help illuminate the development of diagnostic thinking in neurosyphilis.

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy in which facial weakness may occur as a cranial neuropathy. Unilateral facial palsy may also prompt a diagnosis of idiopathic Bell's palsy, creating a risk of diagnostic anchoring when broader neurologic symptoms are already present. We report a 32-year-old man with childhood epilepsy who described progressive bilateral upper and lower extremity weakness with paresthesias for approximately two weeks, followed by left facial paralysis about one week later. He also reported co-administration of hepatitis B, influenza, and tetanus vaccines approximately three weeks before presentation; the vaccine products and dates were not independently verified. An outside hospital treated the facial paralysis as presumed Bell's palsy with acyclovir, although the available records do not establish the facial examination pattern, acyclovir regimen, whether corticosteroids were prescribed there, or whether the preceding bilateral limb symptoms were recognized. An outpatient electrodiagnostic study was reportedly interpreted as concerning for GBS, but the complete nerve conduction/electromyography report was unavailable. Cerebrospinal fluid (CSF) showed white blood cells of 5/mm[3], glucose of 59 mg/dL, and protein of 190 mg/dL, supporting albuminocytologic dissociation; a paired serum glucose was unavailable. The patient completed a five-day course of intravenous immunoglobulin (IVIG), and prednisone plus valacyclovir was also documented for the facial palsy, although their exact dose, route, and duration were not recoverable. The source record documented short-term neurologic improvement before discharge. This case emphasizes that unilateral facial palsy should not distract from pre-existing bilateral weakness and paresthesias and that facial weakness in this setting may represent GBS-related cranial neuropathy rather than a separate confirmed Bell's palsy. The temporal association with vaccination does not establish causality.