Immune checkpoint inhibitors (ICIs) have revolutionised the management of advanced malignancies, but can cause immune-related adverse events (irAEs), including vision-threatening complications such as optic neuropathy. Ocular irAEs have been described with several programmed death-1/programmed death-ligand 1 and cytotoxic T lymphocyte-associated antigen-4 inhibitors, but ocular toxicities of tislelizumab have so far been limited to Vogt-Koyanagi-Harada (VKH)-like uveitis, panuveitis and retinal vasculitis. We describe a woman with metastatic lung adenocarcinoma who was treated with second-line gemcitabine, carboplatin and tislelizumab. After the second cycle of chemo-immunotherapy, she developed painless, progressive bilateral visual blurring in the absence of intracranial disease. Ophthalmic assessment was consistent with toxic optic neuropathy in the context of ongoing tislelizumab exposure, and other causes were excluded. Tislelizumab was discontinued and high-dose intravenous methylprednisolone (1 g/day for 5 days) was administered, without ICI re-challenge. Visual function did not improve, indicating an irreversible optic nerve injury. To our knowledge, this is the first reported case of toxic optic neuropathy associated with tislelizumab, extending the spectrum of tislelizumab-related ocular irAEs beyond previously documented VKH-like panuveitis, VKH-like uveitis and retinal vasculitis. This case highlights the importance of early recognition of visual symptoms and periodic ophthalmic assessment in patients receiving ICIs, as well as decision-making regarding ICI continuation or discontinuation when sight-threatening neuro-ophthalmic irAEs are suspected.

A woman in her late 40s presented with abdominal sepsis secondary to emphysematous pyelitis complicated by a retroperitoneal urinoma. Despite initial antimicrobial therapy, percutaneous drainage and ureteric stenting, she developed persistent thigh pain and a posterior knee sinus. Repeat cross-sectional imaging demonstrated caudal spread of infected retroperitoneal fluid and gas along the iliopsoas and fascial planes into the thigh. Subsequent imaging identified a fistulous communication involving the colon. The exact sequence of fistula formation could not be determined, and causation between the urinary pathology and colonic communication remains uncertain. Management required multidisciplinary input, broad-spectrum antimicrobial therapy, urinary decompression, radiological drainage, bowel diversion and repeated surgical debridement. The patient recovered with resolution of sepsis and restoration of mobility. This case highlights the importance of recognising atypical limb symptoms in retroperitoneal infection and repeating imaging when clinical progress is not as expected.

The management of a snakebite is often challenging due to limited experience, limited access to intensive care, delays in presentation and high variability in venom composition and specific antivenom availability. Classified within the genus Eristicophis, the MacMahon viper is a venomous snake species for which only two detailed case reports exist. Its venom has predominantly haemotoxic properties while neurotoxic and cytotoxic effects are less pronounced. This case illustrates the effects of Eristicophis macmahonii venom on both haemostasis and cardiovascular stability, in addition to a significant local envenomation reaction that required intervention. Laboratory analysis revealed a rapid onset of thrombocytopenia and impaired haemostatic function expressed in rotational thromboelastometry (ROTEM) analysis. The first 6 hours represented an acute phase with significant hypotension and associated syncope. In the absence of clinical signs of bleeding, transfusion of blood products or administration of coagulation factors was not initiated. Thrombocytopenia resolved spontaneously within 8 days.

Radiation fibrosis (RF) is the insidious tissue damage caused by radiation therapy. RF syndrome (RFS) describes the clinical manifestations resulting from RF. Every body system in or traversing the radiation field can be affecting including all neural structures (brain, spinal cord, nerve root, plexus, peripheral nerve, and muscle) and visceral structures (heart, lung, gastrointestinal [GI], etc.). Accurate and comprehensive identification and evaluation of RFS is key to optimizing rehabilitative interventions and maximizing the survivors' function and quality of life.

Emergency airway management in acute brain injury carries unique physiologic risks, such as hypotension, hypoxia, hypercarbia, and sympathetic surges can precipitate secondary brain injury. This review outlines a neuroprotective approach focused on deliberate preparation, physiologic optimization, and evidence-informed techniques. Key elements include rapid ABCD assessment, recognition of elevated intracranial pressure, appropriate use of hyperosmolar therapy, strategies to blunt sympathetic surges, tailored induction and paralysis, techniques to maximize first-pass success, and postintubation ventilation and sedation aimed at maintaining eucapnia, normoxia, and stable cerebral perfusion. This approach reframes intubation as an opportunity to prevent secondary injury and improve outcomes.

The initial management of a critically ill burn patient sets the trajectory for their entire hospital course. Understanding standards of care is essential, but moving beyond rote formulas for airway management, fluids, and analgesia is critical to ensuring appropriate care and preventing iatrogenic harm. This article provides an evidence-based guide for emergency physicians on when and how to pivot from standard care to nuanced, life-saving interventions that address the dynamic pathophysiology of severe burns.

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHIs) that can currently only be diagnosed by neuropathological examination. Recent advancements in the field of CTE research have identified actionable knowledge gaps that pertain to the disease's pathophysiology, clinical expression and in vivo detection. This review provides a structured "Top 10″ overview of established findings and emerging frontiers in CTE research. We summarize the neuropathological diagnosis of CTE, RHI as a risk factor, factors influencing susceptibility, co-occurring pathologies and clinical expression. We review current approaches to in vivo detection, including neuroimaging and fluid biomarkers, noting their applications and limitations, particularly with respect to disease specificity. By integrating findings across neuropathology, risk factors, clinical expression and biomarker development, we aim to clarify where the field stands and identify priorities for future research.

The purpose of this text is to describe the mechanism of injury of the 4 most common malleolar fractures and to present it in terminology and description as it is currently understood in the podiatric profession. We will go through the individual and specific ankle fracture patterns of the original Lauge Hansen Classification and identify the discrepancies in description and interpretation. Each individual category will then be presented within the understanding of common podiatric biomechanics so that the uniqueness of each injury is logically presented and understood.